[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
CLOSE TO HOME: HOW OPIOIDS
ARE IMPACTING COMMUNITIES
=======================================================================
JOINT HEARING
BEFORE THE
SUBCOMMITTEE ON EARLY CHILDHOOD,
ELEMENTARY, AND SECONDARY EDUCATION
AND THE
SUBCOMMITTEE ON HIGHER EDUCATION AND
WORKFORCE DEVELOPMENT
OF THE
COMMITTEE ON EDUCATION
AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, NOVEMBER 8, 2017
__________
Serial No. 115-28
__________
Printed for the use of the Committee on Education and the Workforce
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: www.gpo.gov/fdsys/browse/
committee.action?chamber=house&committee=education
or
Committee address: http://edworkforce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
27-367 PDF WASHINGTON : 2018
-----------------------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Publishing Office,
http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,
U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free).
E-mail, [email protected].
COMMITTEE ON EDUCATION AND THE WORKFORCE
VIRGINIA FOXX, North Carolina, Chairwoman
Joe Wilson, South Carolina Robert C. ``Bobby'' Scott,
Duncan Hunter, California Virginia
David P. Roe, Tennessee Ranking Member
Glenn ``GT'' Thompson, Pennsylvania Susan A. Davis, California
Tim Walberg, Michigan Raul M. Grijalva, Arizona
Brett Guthrie, Kentucky Joe Courtney, Connecticut
Todd Rokita, Indiana Marcia L. Fudge, Ohio
Lou Barletta, Pennsylvania Jared Polis, Colorado
Luke Messer, Indiana Gregorio Kilili Camacho Sablan,
Bradley Byrne, Alabama Northern Mariana Islands
David Brat, Virginia Frederica S. Wilson, Florida
Glenn Grothman, Wisconsin Suzanne Bonamici, Oregon
Steve Russell, Oklahoma Mark Takano, California
Elise Stefanik, New York Alma S. Adams, North Carolina
Rick W. Allen, Georgia Mark DeSaulnier, California
Jason Lewis, Minnesota Donald Norcross, New Jersey
Francis Rooney, Florida Lisa Blunt Rochester, Delaware
Paul Mitchell, Michigan Raja Krishnamoorthi, Illinois
Tom Garrett, Jr., Virginia Carol Shea-Porter, New Hampshire
Lloyd K. Smucker, Pennsylvania Adriano Espaillat, New York
A. Drew Ferguson, IV, Georgia
Ron Estes, Kansas
Karen Handel, Georgia
Brandon Renz, Staff Director
Denise Forte, Minority Staff Director
------
SUBCOMMITTEE ON EARLY CHILDHOOD, ELEMENTARY, AND SECONDARY EDUCATION
TODD ROKITA, Indiana, Chairman
Duncan Hunter, California Jared Polis, Colorado
David P. Roe, Tennessee Ranking Member
Glenn ``GT'' Thompson, Pennsylvania Raul M. Grijalva, Arizona
Luke Messer, Indiana Marcia L. Fudge, Ohio
David Brat, Virginia Suzanne Bonamici, Oregon
Tom Garrett, Jr., Virginia Susan A. Davis, California
Karen Handel, Georgia Frederica S. Wilson, Florida
SUBCOMMITTEE ON HIGHER EDUCATION AND WORKFORCE DEVELOPMENT
BRETT GUTHRIE, Kentucky, Chairman
Glenn ``GT'' Thompson, Pennsylvania Susan A. Davis, California
Lou Barletta, Pennsylvania Ranking Member
Luke Messer, Indiana Joe Courtney, Connecticut
Bradley Byrne, Alabama Alma S. Adams, North Carolina
Glenn Grothman, Wisconsin Mark DeSaulnier, California
Elise Stefanik, New York Raja Krishnamoorthi, Illinois
Rick W. Allen, Georgia Jared Polis, Colorado
Jason Lewis, Minnesota Gregorio Kilili Camacho Sablan,
Paul Mitchell, Michigan Northern Mariana Islands
Tom Garrett, Jr., Virginia Mark Takano, California
Lloyd K. Smucker, Pennsylvania Lisa Blunt Rochester, Delaware
Ron Estes, Kansas Adriano Espaillat, New York
C O N T E N T S
----------
Page
Hearing held on November 8, 2017................................. 1
Statement of Members:
Davis, Hon. Susan, A., Ranking Member, Subcommittee on Higher
Education and Workforce Development........................ 8
Prepared statement of.................................... 9
Guthrie, Hon. Brett, Chairman, Subcommittee on Higher
Education and Workforce Development........................ 6
Prepared statement of.................................... 7
Polis, Hon. Jared, Ranking Member, Subcommittee on Early
Childhood, Elementary, and Secondary Education............. 3
Prepared statement of.................................... 5
Rokita, Hon. Todd, Chairman, Subcommittee on Early Childhood,
Elementary, and Secondary Education........................ 1
Prepared statement of.................................... 3
Statement of Witnesses:
Cox, Dr. David, Partner, Superintendent, Allegany County..... 41
Prepared statement of.................................... 43
Miner, Ms. Toni, Family Support Partner...................... 18
Prepared statement of.................................... 20
Robinson, Mr. Tim, Founder and CEO, Addiction Recovery Care.. 11
Prepared statement of.................................... 14
Wen, Dr. Leana, Commissioner, Baltimore City Health
Department................................................. 27
Prepared statement of.................................... 29
Additional Submissions:
Adams, Hon. Alma, a Representative in Congress from the State
of North Carolina:
Article: President Trumps Says He Wants to Stop the
Opioid Crisis, His Actions Don't Match................. 77
Courtney, Hon. Joe, a Representative in Congress from the
State of Connecticut:
Graph.................................................... 80
Ms. Davis:
Article: Medicaid: States' Most Powerful Tool to Combat
the Opioid Crisis...................................... 82
Mr. Polis:
Article: Medical Cannabis Laws and Opioid Analgesic
Overdose Mortality in the United States, 1999-2010..... 90
Letter dated May 2, 2017, The American Health Care Act
Vote................................................... 97
Questions submitted for the record by Fudge, Hon Marcia a
Representive in Congress from the State of Ohio........ 102
Dr. Wen's responses to questions submitted for the record 104
CLOSE TO HOME: HOW OPIOIDS ARE IMPACTING COMMUNITIES
----------
Wednesday, November 8, 2017
House of Representatives
Committee on Education and the Workforce,
Subcommittee on Early Childhood, Elementary,
and Secondary Education
joint with
Subcommittee on Higher Education and Workforce Development
Washington, D.C.
----------
The subcommittees met, pursuant to call, at 10:30 a.m., in
Room 2175, Rayburn House Office Building, Hon. Todd Rokita
[chairman of the subcommittee on Early Childhood, Elementary,
and Secondary Education] presiding.
Present: Representatives Rokita, Guthrie, Barletta, Messer,
Byrne, Brat, Grothman, Stefanik, Allen, Lewis, Mitchell,
Smucker, Handel, Polis, Davis, Courtney, Fudge, Bonamici,
Adams, DeSaulnier, Blunt Rochester, Krishmamoorthi, and
Espaillat.
Also Present: Representatives Foxx, Scott, and Shea-Porter.
Staff Present: Courtney Butcher, Director of Member
Services and Coalitions; Michael Comer, Press Secretary;
Kathlyn Ehl, Professional Staff Member; Rob Green, Director of
Workforce Policy; Amy Raaf Jones, Director of Education and
Human Resources Policy; Jonas Linde, Professional Staff Member;
Nancy Locke, Chief Clerk; Kelley McNabb, Communications
Director; Jake Middlebrooks, Legislative Assistant; James
Mullen, Director of Information Technology; Krisann Pearce,
General Counsel; James Redstone, Professional Staff Member;
Mandy Schaumburg, Education Deputy Director and Senior Counsel;
Michael Woeste, Press Secretary; Tylease Alli, Minority Clerk/
Intern and Fellow Coordinator; Jacque Chevalier, Minority
Director of Education Policy; Mishawn Freeman, Minority Staff
Assistant; Carolyn Hughes, Minority Director Health Policy/
Senior Labor Policy Advisor; Stephanie Lalle, Minority Digital
Press Secretary; Richard Miller, Minority Labor Policy
Director, Udochi Onwubiko, Minority Labor Policy Counsel; and
Veronique Pluviose, Minority Staff Director.
Chairman Rokita. A quorum being present the Subcommittee on
Early Childhood, Elementary, and Secondary Education and the
Subcommittee on Higher Education and Workforce Development will
come to order.
Today we will have opening statements from the chairman and
the ranking members of our two subcommittees. And, with that, I
recognize myself for an opening statement.
Good morning and welcome to today's joint subcommittee
hearing with our colleagues from the Subcommittee on Higher
Education and Workforce Development. I would like to thank our
panel of witnesses and our members today for joining on this
important discussion on opioid abuse and addiction that is
taking a toll on the Nation as we see every night on our
television sets, if not from other places.
The opioid crisis is having a profound impact on families,
jobs, communities, and the economy, and that is why we are here
today. The issue of drug overdoses due to opioids is only
getting worse as death related opioids have quadrupled since
1999. And we have some fast facts up on the screen detailing
all of this. In fact, in 2016 alone there were approximately
64,000 fatal drug overdoses. This means that the opioid crisis
is claiming the lives of 175 Americans per day. These figures
are horrifying and sad, not only for the country's future, but
for communities who are losing parents, husbands, wives,
teachers, and, yes, students.
Additionally, the opioid epidemic knows no age, gender,
educational, credential, or class distinction. This crisis is
touching all of us. Some of the most unfortunate stories have
to do with children whose lives have been forever changed by
this public health emergency. Between 2000 and 2014 the number
of babies born drug-dependent increased by 500 percent. In my
home State of Indiana a recent pilot program from the State
Department of Health found that about one in five infants
assessed at hospitals around the State tested positive for
opioids, 20 percent of our babies in Indiana.
More and more children are being placed into foster care or
are cared for by another relative due to parental drug abuse.
According to a recent analysis nearly a third of the children
who entered foster care in the U.S. in 2015 alone did so at
least partially because of parental drug abuse.
It is one thing to read the statistics and accounts in the
news about communities in the midst of an opioid crisis, but
these accounts do not compare to the real voices we need to
hear from in order to understand this crisis.
I had the opportunity to host a school safety summit last
week in my district. One of the two significant topics was the
opioid crisis. I heard from Dustin Noonkester, one of the
founders of Brady's Hope. Dustin lost his son to opioid
overdose. This organization is a resource to members of the
community on how to spot abuse, how to address opioid misuse,
and how families can help one another treat opioid addiction.
Brady was a good student, he was off to a military career and
he had 2 weeks to go before boot camp when his life was claimed
by this. And it happened over the course of one summer. Started
meeting with kids that he hadn't before, and one thing led to
another and he was 2 weeks short of getting to boot camp where
his life would have been saved.
The epidemic can no longer be ignored and it is important
that we hear from those who are on the ground and facing tragic
truths of this opioid crisis every day. The witnesses we have
gathered here today understand the opioid problem better than
any of us here in Washington perhaps because they see it and
they fight it in their communities nearly every hour of every
day. So I am pleased this committee can come together to
understand this true public health emergency and its impact on
communities across the United States.
And with that, it is now my pleasure to yield to the
ranking member of the Subcommittee on Early Childhood,
Elementary, and Secondary Education, and my friend, Congressman
Polis for his opening remarks.
[The information follows:]
Prepared Statement of Hon. Todd Rokita, Chairman, Subcommittee on Early
Childhood, Elementary, and Secondary Education
Good morning, and welcome to today's joint subcommittee hearing
with our colleagues from the Subcommittee on Higher Education and
Workforce Development. I'd like to thank our panel of witnesses and our
members for joining today's important discussion on opioid abuse and
addiction that is taking a toll on the nation.
The opioid crisis is having a profound impact on families, jobs,
communities, and the economy, and that is why we're here today.
The issue of drug overdoses due to opioids is only getting worse as
deaths related to opioids have quadrupled since 1999. In 2016 alone,
there were approximately 64,000 drug overdoses. This means that the
opioid crisis is claiming the lives of 175 Americans per day.
These figures are horrifying and sad not only for the country's
future, but for communities who are losing parents, husbands, wives,
teachers, and students.
Additionally, the opioid epidemic knows no age, gender, educational
credential, or class distinction. This crisis is touching all
Americans.
Some of the most unfortunate stories have to do with the children
whose lives have been forever changed by this public health emergency.
Between 2000 and 2014, the number of babies born drug-dependent
increased by 500 percent. In my home state of Indiana, a recent pilot
program from the state Department of Health found that about 1 in 5
infants assessed at hospitals around the state tested positive for
opiates.
More and more children are being placed into foster care or are
cared for by another relative due to parental drug abuse. According to
a recent analysis, nearly a third of the children who entered foster
care in the U.S. in 2015 did so at least partially because of parental
drug abuse.
It is one thing to read the statistics and accounts in the news
about communities in the midst of the opioid crisis, but these accounts
do not compare to the real voices we need to hear from in order to
understand this crisis.
I had the opportunity to host a school safety summit last week in
my district. One of the two big topics was the opioid crisis. I heard
from Dustin Noonkester, one of the founders of ``Brady's Hope.'' Dustin
lost his son to opioid overdose. This organization is a resource to
members of the community on how to spot abuse, how to address opioid
misuse, and how families can help one another treat opioid addiction.
These are the stories that give me hope that this crisis can be
overcome.
This epidemic can no longer be ignored, and it is important that we
hear from those who are on the ground and facing the tragic truths of
the opioid crisis every day.
The witnesses we have gathered here today understand the opioid
problem better than any of us here in Washington, because they see it,
and fight it, in their communities.
I am pleased this committee can come together to understand this
true public health emergency and its impact on communities across the
United States.
______
Mr. Polis. Thank you, Chairman Rokita, for holding this
very important hearing. As we know, the opioid crisis cuts
across State lines, across party lines, it affects each of us
in our congressional districts, and many of us in our
neighborhoods and families. In my home State of Colorado the
rate of drug overdose deaths since 2000 has more than doubled.
The impact of the opioid crisis needs to engender a strong
bipartisan response from Congress, and I am thankful that we
are beginning to have an important discussion through our joint
subcommittee this morning.
Addressing the opioid crisis should be a top priority for
the United States Congress, for our States, for our local
governments. Last year Congress passed, and President Obama
signed, a law with a new set of policies that helped
restructure our prevention and treatment efforts to better
respond to substance abuse problems. Unfortunately, it did not
provide the funding necessary to effect change and this crisis.
We need to match our rhetoric with action and with real
resources. That means understanding the role that many programs
fill in crafting a holistic approach to the crisis, programs
within the jurisdiction of this committee and programs within
the jurisdiction of other committees. For example, early
learning programs, helping care for children who experienced a
trauma of having addicted parents.
Public schools are on the front line in the delivery and
coordination of services for students impacted by addiction.
Congress should fully fund programs authorized under ESSA to
ensure that teachers and school leaders are equipped to be
ready and willing partners in addressing the opioid addiction
and opioid use disorder.
We can't overstate the importance of access to health
coverage in this discussion. Medicaid and the Affordable Care
Act have been improved and expanded to provide healthcare
coverage to many who lacked it. In my home State alone 400,000
Coloradans have access to health insurance through the Medicaid
expansion alone.
Finally, as we address the opioid addiction crisis we have
to remember that many communities were suffering from substance
abuse disorders long before this current crisis. While the
level and number of deaths has increased, addiction has always
been a problem in our communities, in both rural communities,
in urban and suburban communities, in every congressional
district.
We need to think critically about alternative options to
addressing this crisis. For some communities, such as veterans,
as we see in Colorado, cannabis should be considered as a
replacement therapy for chronic pain management. Research
suggests that implementing medical cannabis programs can reduce
pain management medications associated with mortality, like
opioid prescription drugs. It also can improve pain management
and significantly reduce healthcare costs. In fact, a recent
Journal of American Medical Association study analyzed all 50
States and found that those with medical marijuana laws had 25
percent fewer fatal opioid overdoses than States that did not
have those laws between 1999 and 2010.
At this time I ask unanimous consent to place this study in
the record.
Chairman Rokita. Without objection.
Mr. Polis. Recently I was honored to present a Purple Heart
to a veteran who lives in my district. This 29-year-old man put
his life on the line for our country and he told me he uses
medical marijuana for all of his pain management and sleep
issues and he has been able to successfully take himself off of
the prescription opioids that the VA prescribed. His girlfriend
also bore witness to the fact that he is much better for it.
And these are the kinds of stories and data that we need to
look at in addressing the opioid crisis.
It is encouraging that Congress is taking this time to
discuss the issue, and it is important that this committee is
staying involved in the Federal response to the opioid
epidemic. I know that members on both sides of the aisle will
have thoughtful questions and ideas both to address the under
resourcing of programs and to make sure that we can address
this issue in a comprehensive manner.
I want to thank our panelists for taking the time to
testify today. I look forward to hearing from everybody.
And I yield back the balance of my time.
[The information follows:]
Prepared Statement of Hon. Jared Polis, Ranking Member, Subcommittee on
Early Childhood, Elementary, and Secondary Education
Thank you, Chairman Rokita, for holding this important hearing
today.
As each of us here knows, the opioid crisis is one that cuts across
state lines and affects each of our congressional districts. In
Colorado, the rate of drug overdose deaths since 2000 has more than
doubled. The impact of the opioid crisis isn't a partisan issue, and
our response shouldn't be either. I'm thankful we're able to discuss
this important issue at our joint subcommittee hearing this morning.
Addressing the opioid crisis should be a top priority for Congress.
Last year, Congress passed and President Obama signed into law a set of
policies that helped restructure our prevention and treatment efforts
to better respond to substance use disorder. It did not, however,
provide the funding necessary to affect the change needed to address
this crisis.
To truly respond to this epidemic, we have to walk the walk, and
without funding, we will not be doing enough for our constituents to
move the needle.
We must match our rhetoric with action and real money. That means
understanding the role that many programs fill in crafting a holistic
approach to this crisis - programs within the jurisdiction of this
Committee. For example, early learning programs help care for children
who experience the trauma of having addicted parents. Public schools
are on the front line in the delivery and coordination of services for
students impacted by addiction. Congress must fully fund programs
authorized under ESSA to ensure that teachers and school leaders are
equipped to be ready partners in addressing opioid addiction and opioid
use disorder.
We also cannot overstate the importance of access to health
coverage in this discussion. Medicaid and the Affordable Care Act have
dramatically improved and expanded access to health coverage, a vital
part of responding to opioid use disorder and ensuring that Americans
can get both needed preventive care and treatment. In my state alone,
over 400,000 Coloradans have access to health insurance now through the
Medicaid expansion.
But for the last ten months and counting, we have wasted precious
time trying to repeal the Affordable Care Act and Medicaid expansion.
This is especially cruel because 1.6 million people with substance
abuse disorders now have access to treatment precisely because 31
states expanded Medicaid as part of the ACA.
Even last week, House Republicans advanced a bill that would cut
billions from the Affordable Care Act's Public Health and Prevention
Fund, which helps states prevent and respond to the opioid epidemic.
Finally, as we address the opioid addiction, we have to remember
that many communities were suffering from substance use disorders long
before Congress woke up to this issue. Addiction affects both rural and
urban communities and every Congressional district. Efforts to address
addiction through treatment, instead of incarceration and instead of
punishment, should apply to all communities as well.
We also need to think critically about alternative options to
addressing this crisis. For some communities, such as veterans,
cannabis should be considered as a replacement therapy for chronic pain
treatment. Early research suggests implementing medical cannabis
programs could reduce pain management medications associated mortality,
improve pain management, and significantly reduce health care costs. In
fact, a recent Journal of American Medical Association study analyzed
all 50 states and found that those with medical marijuana laws had 25%
fewer fatal opioid overdoses than states that had no such laws between
1999 and 2010.
At this time, I ask unanimous consent to place this study into the
record.
Recently, I was honored to present a Purple Heart to a veteran who
lives in Boulder, Colorado. This 29 year old young man put his life on
the line for our country. He told me that he uses medical marijuana for
all his pain and sleep issues, and has been able to take himself off
all opioids the VA had prescribed. His girlfriend testified to the fact
that he's so much better for it. These are the type of stories we need
to listen to.
It's encouraging that Congress is taking time to discuss this issue
and it is important that this Committee stay very involved in the
federal response to the opioid epidemic. I am hopeful that we can
address it through increased funding for effective, under-resourced
programs and locally-driven state and federal initiatives that are
built on evidence-based practices, not stigma or misperceptions about
proven treatment strategies.
I thank the panelists for taking the time to testify today. I look
forward to hearing from you.
Thank you, and I yield back the balance of my time.
______
Chairman Rokita. I thank the gentleman. I will now yield to
the chairman of the Subcommittee on Higher Education and the
Workforce for his opening remarks.
Chairman Guthrie. Thank you, Chairman Rokita. I want to
echo the chairman's appreciation for the witnesses here today.
The opioid crisis is having a profound impact on my
constituents as well. And I am sure the stories we hear from
the witnesses today resonate with many of the stories I have
heard in Kentucky. The opioid crisis is a public health
emergency and Congress must continue working to face the
epidemic that has had an impact on all aspects of our society.
Unfortunately, a problem as widespread as the opioid epidemic,
which has already had an impact of 11.5 million Americans has
also taken a devastating toll on local economies and the
national economy as a whole, and we are only beginning to see
more clearly. As the opioid health emergency continues to
worsen, the economy will continue to suffer. Data from CDC
analyzing opioid overdose deaths by age groups in 1999 and 2015
show that people most likely to die of an opioid overdose are
between the ages of 25 and 39 years old. These are people who
have entire lives, careers, and untold contributions to make to
their communities and our country ahead of them. Numbers are
important, but people with their own stories are at the heart
of this crisis.
To Americans who live in some of the areas hardest hit by
the opioid crisis, including my home State of Kentucky, they
are seeing their coworkers, bosses, friends, and family members
suffer from this horrible affliction. The administration and
Congress are coming together to identify community-based
solutions to combat this crisis. But the day-to-day hard work
fighting this outbreak is already being done on the ground by
the people that face this issue every day. The witnesses we
have gathered here today have seen the impact the opioid crisis
is having on their communities every day and it is important we
hear the stories of how it specifically impacted them as
individuals, as well as their friends, families, and coworkers.
When it comes to finding solutions for the workforce
development needs and creating more good paying jobs, we look
to State and local entities who are leading by example and the
opioid crisis is no different. Our witnesses before us have
learned a lot in their communities about how to spot opioid
abuse and implement successful forms of treatment. It is
important we hear about these experiences in order to inform
the congressional response to this crisis.
At this committee we talk a lot about how we are addressing
the shortage of skilled workers across the country and how we
want to empower people to build the lives they want for
themselves. For many workers ensnared in this epidemic, it is
critical that they receive the treatment they need to help them
return to the workforce and to find a good job once they are
drug free. We also have to acknowledge that the opioid crisis
resulting in too many lives ending far too soon and we have to
look at ways to stop it.
I would like to welcome Tim Robinson here today from my
home State of Kentucky. I know that Tim and I were discussing
earlier Louisa, where he is from, is probably closer to this
capital building than it is to my hometown of Bowling Green,
but it just shows how broad and wide and diverse Kentucky is
and the problem is pervasive through all economic groups, all
people, and it is something that we are struggling with. I know
that the dean of the Kentucky delegation, Hal Rogers, has been
a strong supporter of what you do in Louisa and Martin County
and all through Appalachia, and also across the Commonwealth.
So I certainly appreciate you being here today and your
testimony in a few minutes. I appreciate the witnesses for
appearing and I look forward to hearing your testimony.
And I yield back.
[The information follows:]
Prepared Statement of Hon. Brett Guthrie, Chairman, Subcommittee on
Higher Education and Workforce Development
Thank you Subcommittee Chairman Rokita, and I want to echo the
Chairman's appreciation for the witnesses joining us at today's
hearing. The opioid crisis is having a profound impact on my
constituents as well, and I'm sure the stories we will hear from the
witnesses today will resonate with many of the stories I have heard in
Kentucky.
The opioid crisis is a public health emergency and Congress must
continue working to face the epidemic that has had an impact on all
aspects of our society.
Unfortunately, a problem as widespread as the opioid epidemic,
which has already had an impact on over 11.5 million Americans, also
has taken a devastating toll on local economies and the national
economy as a whole, as we're only beginning to see more clearly.
As the opioid public health emergency continues to worsen, the
economy will continue to suffer.
Data from the CDC analyzing opioid overdose deaths by age groups in
1999 and 2015 showed that the people most likely to die of an opioid
overdose are between the ages of 25 and 39 years old.
These are people who had entire lives, careers, and untold
contributions to make to their communities and our country ahead of
them.
Numbers are important, but people with their own stories are at the
heart of this crisis.
To Americans who live in some of the areas hardest hit by the
opioid crisis, including my home state of Kentucky, they are seeing
their coworkers, bosses, friends, and family members suffer from this
horrible affliction.
The administration and Congress are coming together to identify
community-based solutions to combat this crisis, but the day-to-day
hard work fighting this outbreak is already being done on the ground by
the people that face this issue every day.
The witnesses we have gathered here today have seen the impact the
opioid crisis is having on their communities every day, and it's
important we hear their stories of how it has specifically impacted
them as individuals, as well as their friends, families, and coworkers.
When it comes to finding solutions for workforce development needs,
and creating more good-paying jobs, we look to state and local entities
who are leading by example, and the opioid crisis is no different.
Our witnesses before us have learned a lot in their communities
about how to spot opioid abuse and implement successful forms of
treatment. It is important we hear about these experiences in order to
inform the Congressional response to the crisis.
At this Committee, we talk a lot about how we are addressing the
shortage of skilled workers across the country, and how we want to
empower people to build the lives they want for themselves. For many
workers ensnared in this epidemic, it is critical that they receive the
treatment they need to help them return to the workforce, and find a
good job once they are drug-free. We also have to acknowledge that the
opioid crisis is resulting in too many lives ending far too soon, and
we have to look at ways to stop it.
I'd like to welcome Tim Robinson from my home state of Kentucky who
is testifying here today. Tim is the founder and CEO of Addiction
Recovery Care in Louisa, Kentucky, which is a network of 13 addiction
treatment centers. Thank you for the work you are doing to serve your
community and the Commonwealth. I look forward to hearing your
testimony today.
I appreciate the witnesses for appearing before this committee, and
look forward to hearing how they have responded in their own
communities to combat this crisis.
______
Chairman Rokita. Thank you, Chairman Guthrie, and I yield
to the ranking member of the Subcommittee on Higher Education &
the Workforce, Congresswoman Davis, for her opening remarks.
Ms. Davis. Thank you. Thank you, Mr. Chair. As my
colleagues have said, and I want to point how much in sync I
think that we are on many of these issues, the opioid crisis
has greatly impacted our communities. In 2015, more than 33,000
Americans died of an opioid overdose and more than 2 million
individuals had an opioid use disorder.
In California, more people die from drug overdose each year
than from auto accidents. And that is why it is so important to
continue to invest in the Federal programs that promote
addiction recovery and treatment. Across the country and in
California Medicaid has been vital to addressing the opioid
epidemic. Adults with Medicaid coverage are about three times
more likely to have received treatment as inpatients and almost
twice as likely to have received outpatient treatment than
privately insured adults. As Ranking Member Polis has noted, in
our efforts to combat this epidemic it is vital that we invest
in the systems, systems and the programs that support healthy
families in communities, and this means a strong workforce. And
I am pleased that my colleague has also echoed that interest.
As we have seen with past drug epidemics that have rocked
our communities the opioid epidemic has a strong link to jobs.
According to recent research an estimated 25 percent of the
drop in women's workforce participation between '99 and 2015
can be attributed to the increase in opioid prescriptions, and
for men that number is about 20 percent. And we know that when
adults, particularly women, are not working it has significant
impacts on the economic security of their families and
communities.
For example, job loss for a parent can mean lower wages and
unemployment for their children later in life. It is
particularly important to note the relationship between opioid
abuse and unemployment. This means that individuals may fall
out of the job force due to their dependence on opioids or it
may be that they become addicted after job loss. We must help
people remain employed and breakdown the barriers for
individuals struggling with opioid abuse problems as they seek
to reenter the workforce. And this means rethinking employer
drug testing policies and using a more thoughtful approach for
those in the criminal justice system. We must also leverage our
workforce development systems to ensure that our workers,
especially those in communities impacted by trade and
technology, have access to the skills development that they
need. Integrating job training into treatment efforts is also
key. Linking these services can be crucial for helping people
reenter the workforce and improve the probability of long-term
recovery efforts.
Now, we know that the Trump administration has declared a
nationwide public health emergency to address the opioid
crisis. And as part of this declaration the administration has
directed the Department of Labor to use dislocated worker
grants to, ``Help workers who have been displaced from the
workforce because of the opioid crisis subject to available
funding.'' Unfortunately, we will not be hearing from anyone
from the administration today to get a better understanding of
their plans. And that perspective would have been very helpful
I believe for understanding why they would encourage the use of
these grants but also, at the same time, call for a 40 percent
cut to their funding.
As I am sure many of my colleagues today will underscore,
substance abuse and its impacts on communities is nothing new.
And if there is anything that we have learned from past
failures in addressing this problem it is that resources do
matter. In addition to investing in treatment and recovery
programs at the back end, we must also address the poverty, the
violence, poor healthcare, and inadequate education that can be
contributing factors to unhealthy communities.
I look forward to hearing about what investments are needed
to address a crisis of this magnitude without robbing other
vital programs, such as family support services and job
training that support families and communities.
I want to thank the witnesses for being here today. And I
certainly want to congratulate Dr. Leana Wen on her newest
addition to her family. I look forward to your testimony and
hearing more about how we can address and help communities
impacted by the opioid abuse exist its crisis.
Thank you very much for being here.
[The information follows:]
Prepared Statement of Hon. Susan A. Davis, Ranking Member, Subcommittee
on Higher Education and Workforce Development
As my colleagues have said, the opioid crisis has greatly impacted
our communities. In 2015, more than 33,000 Americans died of an opioid
overdose, and more than 2 million individuals had an opioid use
disorder. In California, more people die from drug overdose each year
than from auto-accidents.
That's why it's so important to continue to invest in the federal
programs that promote addiction recovery and treatment.
Across the country and in California, Medicaid has been vital to
addressing the opioid epidemic. Adults with Medicaid coverage are about
three times more likely to have received treatment as inpatients, and
almost twice as likely to have received outpatient treatment, than
privately insured adults.
As Ranking Member Polis noted, in our efforts to combat this
epidemic, it's vital that we invest in the systems and programs that
support healthy families and communities. This means a strong
workforce. As we've seen with past drug epidemics that have rocked our
communities, the opioid epidemic has a strong link to jobs. According
to recent research, an estimated 25 percent of the drop in women's
workforce participation between 1999 and 2015 can be attributed to the
increase in opioid prescriptions. For men, that number is about 20
percent.
And we know that when adults, particularly women, aren't working,
it has significant impacts on the economic security of families and
communities beyond the immediate loss of income. For example, job loss
for a parent can translate into lower wages and difficulty remaining in
the labor market for their children later in life.
It's particularly important to note the relationship between opioid
abuse and unemployment. This means that individuals may fall out of or
have difficulty staying in the job force due to their dependence on
opioids or may become addicted after job loss.
We must help individuals remain employed and break down barriers to
individuals with substance use disorders re-entering the workforce.
This means rethinking employer drug testing policies and using a more
thoughtful approach to employment for those with involvement in the
criminal justice system. We must also leverage our workforce
development system to ensure our nation's workers, especially those in
communities or industries impacted by trade and technology, have access
to the jobs and skills development they need.
Integrating job training into recovery and treatment efforts is
also key. Linking these services can be crucial for helping people re-
enter the workforce and improve the probability of recovery efforts
long term.
So I look forward to hearing about how our current system can be
improved, including ideas on providing key services in the same
location, or best practices for partnerships between the workforce
development and health systems.
Now, we know that the Trump Administration has declared a
Nationwide Public Health Emergency to address the opioids crisis. As
part of this declaration, the administration has directed the
Department
of Labor to use Dislocated Worker Grants ``to help workers who have
been displaced from the workforce because of the opioid crisis, subject
to available funding.''
Unfortunately, we will not be hearing from anyone from the
administration today to get a better understanding of their plans. That
perspective would have been key in understanding why they would
encourage the use of these grants while calling for a 40 percent cut to
this funding.
As I'm sure many of my colleagues today will underscore, substance
abuse and its impacts on communities is nothing new. And if there's
anything we've learned from our nation's past failures in addressing
substance abuse issues and supporting impacted communities, it is that
resources matter.
So I look forward to hearing about what investments are needed to
address a crisis of this magnitude without robbing other vital
programs, such as family support services and job training, that
support healthy families and communities,
I would like to thank the witnesses for being here today. I also
want to congratulate Dr. Leana Wen on the newest addition to her
family.
I look forward to your testimony and hearing more about the how we
can help communities impacted by the opioid abuse crisis.
Thank you.
______
Chairman Rokita. And the gentlelady yields back. Pursuant
to committee rule 7C all members of the subcommittees will be
permitted to submit written statements to be included in the
permanent hearing record. And without objection the hearing
record will remain open for 14 days to allow statements,
questions for the record, and other extraneous material
reference during the hearing to be submitted for the official
record.
We will now turn to the introduction of our distinguished
panel of witnesses, and I yield to Chairman Guthrie to
introduce our first witness.
Chairman Guthrie. First I would like to introduce Mr. Tim
Robinson as the founder and CEO of Addiction Recovery Care, and
it has 13 organizations that are networked through eastern and
central Kentucky, and I talked about him in my previous
remarks. So welcome, and I look forward to your testimony.
I yield back to the chairman.
Chairman Rokita. Thank the gentleman. I yield to Ranking
Member Polis for the introduction of the second witness.
Mr. Polis. Thank you. I am honored to introduce Toni Miner.
Miss Miner is a fellow Coloradan from Jefferson County,
Colorado, which I have the honor of representing much of. She
is currently working as a family support partner with the
Jefferson County Child and Youth Leadership Commission. Prior
to this position Toni Miner served as a family advocate with
the Child and Youth Leadership Commission. She also worked as a
parent partner for 5 years. In addition to mentoring families
she also provides training to caseworkers on the ground. Court-
appointed special advocate volunteers, she helps train as well.
Miss Miner has been active in the Child Welfare System team
decision-making meetings and serves on the Domestic Violence
and Child Protection Services Coordinating Council. Welcome to
our committee.
Chairman Rokita. Thank you. I thank the gentleman and I
will resume introducing our witnesses. Dr. Leana Wen is the
commissioner of health for the city of Baltimore, Maryland. And
Dr. David Cox is the superintendent of schools in Allegany
County, Maryland. Welcome to all the witnesses.
[Witnesses sworn]
Chairman Rokita. And let the record reflect that all
witnesses answered in the affirmative.
Before I recognize each of you to provide your testimony
let me briefly explain our lighting system, and it is a
reminder for us up here as much as it is for you. You will each
have 5 minutes to present your testimony. And when you begin
the light in front of you will be turned green, when 1 minute
is left it will be yellow, and when the time is expired the
light will turn red. At that point I will ask you to wrap up
your remarks. After everyone has testified members up here will
each have 5 minutes to ask questions of each of you.
And so with that, let me recognize Mr. Robinson for 5
minutes.
Thank you, sir.
TESTIMONY OF TIM ROBINSON, FOUNDER AND CEO, ADDICTION RECOVERY
CARE
Mr. Robinson. Good morning. My name is Tim Robinson. I'm
the founder and CEO of Addiction Recovery Care. As already
mentioned, there were more deaths due to overdoses than car
accidents last year, making addiction a public health crisis.
The addiction epidemic is not just costing us thousands of
lives, it is also threatening our economic security as
employers struggle to find and retain employees who can pass
the drug screen. In September, our Kentucky Chamber of Commerce
CEO wrote an op-editorial that called addiction the number one
economic concern in our State.
Everyone is looking for a silver bullet to the addiction
crisis and there is no single intervention that alone is a
silver bullet. Addiction recovery requires a whole person
approach which starts with identifying those in addiction,
intervening with treatment, investing in their economic future
through education and workforce development, and inspiring them
to join the effort to do for others what was done for me, help
another person discover their destiny and work out their
recovery.
I am thankful for the opportunity to speak to you because
recovery is personal to me. I started drinking in my first year
of law school at the University of Kentucky to cope with my mom
passing away from terminal lung cancer during finals. For the
next 8 years I almost drank myself to death. Ten years ago,
while I was a prosecuting attorney in Lawrence County,
Kentucky, a court bailiff who was a recovering alcoholic and a
pastor led me to a spiritual awakening at my desk. He became my
sponsor, but he also became my pastor. And he carried me for a
while and he walked with me and poured his recovery and his
faith into me. Addiction recovery is personal to me because I
am a survivor.
Two years later, I resigned as prosecutor, gave my law
practice to my law partner, and in 2010, opened Karen's Place,
a recovery center for women in eastern Kentucky. Since opening
our first center we've realized that addiction is a disease
that devastates all aspects of a person's life and that a
holistic approach is crucial for long-term recovery. Addiction
impacts someone's mind, body, spirit, and their purpose. And
we've been determined to treat addiction medically, clinically,
spiritually, and vocationally. And though our centers are led
by an addictionologist and are nationally accredited,
Alcoholics Anonymous has taught us that a spiritual awakening
is the foundation of lasting recovery. In that tradition we've
developed a spirituality program that inspires hope and offers
those coming out of an addiction an opportunity to understand
that God is the source to find hope, forgiveness, and
redemption. Much like hospice care centers and Catholic
healthcare systems we employ chaplains and pastoral counselors
who work alongside our clinical staff. And though we consider
the faith-based aspect of our centers to be the heart of our
success, our spirituality program does not replace medical and
evidence-based clinical practices. It's in addition to them and
makes our care more comprehensive.
Treating the whole person has led to great success. Our
clients stay in treatment for 60 to 70 days, compared to a
national average of 25 to 30 days. This objective measure shows
our residential centers to be twice as effective as the
national average.
Readmission is another objective measure. Those in
addiction who relapse most often return to the same center 40
percent of the time. Less than 10 percent of our clients
readmit.
As we have built our treatment network we have had a great
need for addiction treatment workers and we have created an
internship program and issued a challenge. Clients who intern
with us until their 1-year clean mark would be guaranteed a
job. Today 70 of Addiction Recovery Care's 200 employees are
graduates of our program. We formalized their internship
program, becoming a State-certified peer support specialist
training program. A peer support specialist is a recovering
addict who has at least 1 year of sobriety. After a 40-hour
class they become a Medicaid billable behavioral health
practitioner and can provide those in addiction with peer
support.
SOAR, an economic initiative in Kentucky's Fifth
Congressional District, connected us with the Workforce Board
Eastern Kentucky Concentrated Employment Program and their
executive director, Jeff Whitehead. With the Workforce Board
providing funding we partnered with Sullivan University to
transform our internship program into a workforce development
opportunity. Our program graduates become State-certified and
earn a college certificate. There's also soft skills
development and professionalism in workplace ethics. They
receive other skills such as CPR, first aid, and using a
medical record, electronic medical record.
In 2016, we started our first class and 16 peer support
specialists graduated in May of 2017. Out of the 16 graduates,
14 of them were at least 8 months clean and sober today,
working full-time, paying taxes, and transitioning off of
public assistance. These 14 people now have great purpose and
meaningful careers. We now have more than 50 others in the
academy today.
Prior to the academy 40 percent of our clients moved to our
transitional program. After starting the academy, now 70
percent of our clients now choose to continue treatment, which
means treatment----
[The statement of Mr. Robinson follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Rokita. Thank you, Mr. Robinson. I appreciate that
very much. Miss Miner, you are recognized for 5 minutes.
TESTIMONY OF TONI MINER, FAMILY SUPPORT PARTNER
Ms. Miner. Good morning. I wish to thank the Committee on
Education and Workforce for providing me with this opportunity
to share my perspectives with you today.
My name is Toni Miner and I am a birth mother of three
children, Mercedes, Jonell, and Spencer, and the legal guardian
for my two grandchildren, Angel and Tavin. And we live in
Jefferson County, Colorado.
My story is that of a mother who was heavily ruled by her
addiction to methamphetamine. My meth use became daily in 1996
and continued until 2002. Unfortunately, my two beautiful
daughters had to live through my active meth addiction. I
didn't think my meth use really had an effect on my girls as I
was providing a roof over their head, food on the table, and
clothes on their backs. But what my daughters wanted and needed
more than anything in this world was a clean and protective
parent.
Now, during this time of my meth use I received many
criminal charges that were due to my use. I had burned all my
bridges and had no support and I really didn't see any way out
of my addiction. Then I found out that I was pregnant. I had no
idea what I was going to do or how to get clean, but knew that
I had to. I had hit my rock bottom. Because I was finally ready
to get clean I was able to take the first steps and stop my
meth use with the support of my amazing caseworker and
probation officer, who did not judge me, but encouraged me. My
daughters returned to my care the day that I was released with
the understanding that I would comply with the probation
requirements and complete intensive outpatient treatment.
Today, almost 16 years later, I am still clean and actively
involved in a recovery program. I have rebuilt relationships
with family, made many new friends, and have many supports in
my life. Unfortunately, my poor choices did take a toll on my
two daughters who eventually became addicted to drugs. Today as
a kinship care provider, I can make sure that my grandchildren
are safe from any future harm.
Besides working to ensure that my own family is strong and
safe, I also work to help families who are impacted via child
welfare and struggling with addiction. Working as a family
support partner in Jefferson County, Colorado, and also working
in our Problem-Solving Court, which is our family drug court in
Jefferson County, I am able to educate and empower struggling
families with the skills and knowledge to navigate multiple
systems and advocate for their own supports and connections
within the community. I also work with families through
facilitating a circle of parents and recovery group, which are
specialized parent support groups designed to build protective
factors in families, addressing substance abuse and the impact
of trauma.
Through my personal experience and my work with families I
am able to provide you with recommendations that I believe will
help strengthen families, especially during the opioid crisis.
One, collaboration across agencies is a must to ensure that
children and families are getting the right service they need
efficiently. Families interact with multiple systems with their
own requirements, processes, and it is essential that these
systems work together to ensure families get the help they
need. Law enforcement, child welfare, schools, mental health,
housing, courts, hospitals, employers, substance abuse
programs, and methadone clinics should all be part of the
process to help strengthen families struggling with addiction.
Two, focus on the whole family. Addiction is a family
disease. And if the whole family is not treated and provided
the right supports history will continue to repeat itself, as
it did within my own family. Families at risk respond best to
supportive and strengths-based approaches. Both my child
welfare caseworker and probation officer believed that I could
change and become the strong, resilient, and healthy parent
that I am today.
Three, educate our communities and families regarding
substance abuse. Public service announcements must talk about
link between substance abuse and mental health and include
available resources for treatment. Children must be educated,
especially prevention education of the children of adult
addicts.
Four, partner with parents to work with other families
before, during, or after involvement with the child welfare and
court systems. We need to partner with parents like me who have
learned from their own experiences and can help other families
navigate complex systems and access services. Many States and
local jurisdictions are implementing parent partner programs
and finding this can be a very useful strategy to effectively
engage parents in their child welfare cases and treatment.
These voices are also important as they educate policymakers,
administrators, frontline workers, and others interacting with
families.
If we implement these recommendations and invest in
families, the sky is the limit in what we can achieve together.
Thank you for your time.
[The statement of Ms. Miner follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Rokita. Thank you, Ms. Miner. Dr. Wen, you are
recognized for 5 minutes.
TESTIMONY OF LEANA WEN, COMMISSIONER, BALTIMORE CITY HEALTH
DEPARTMENT
Dr. Wen. Chairmen Rokita and Guthrie, Ranking Members Polis
and Davis, thank you for calling this hearing. I am here as an
emergency physician and the Health Commissioner of Baltimore
where overdose claims the lives of two residents a day and
where addiction affects every aspect, from the workforce to our
youngest children.
Baltimore has a three pillar approach. First, we focus on
saving lives by making the opioid antidote, naloxone, or
Narcan, available to everyone. Not only have we equipped
paramedics and the police, I issued a blanket prescription to
all 620,000 of our residents. Since 2015, every day individuals
have saved the lives of 1,500 people. But we have a problem.
Our city is out of funds to purchase naloxone, forcing us to
ration and make decisions every day about who can receive the
antidote. At a time of a public health crisis it is
unconscionable that we are being limited in our ability to save
lives.
Our second pillar is to increase on-demand addiction
treatment. The science is clear: addiction is a disease,
treatment exists, and recovery is possible. Nationwide only 11
percent of patients with addiction get treatment. Imagine if
only 1 in 10 people with cancer can get chemotherapy. Yet, my
patients come to the ER asking for help and I tell them they
must wait weeks or months. I have had patients overdose and die
while they are waiting because our system failed them.
In Baltimore, we started a 24/7 phone hotline that includes
immediate access to a social worker or addiction specialist. We
receive 1,000 calls a week. We are starting a 24/7 ER for
addiction and mental health.
We believe that treating addiction as a crime is
unscientific, inhumane, and ineffective. That's why we have
programs like LEAD, Law Enforcement Assisted Diversion, where
individuals caught with small amounts of drugs will be offered
treatment instead of incarceration.
Law enforcement to stop the trafficking of drugs is
important as is more judicious prescribing by doctors. However,
reducing the supply of drugs will not work unless there is
equal attention to curbing demand through providing treatment.
That means the Federal Government should do everything possible
to expand insurance coverage. One in three patients with
addiction depend on Medicaid. If Medicaid were gutted and they
were to lose coverage many more would overdose and die. Other
patients on private insurance could find themselves without
access to treatment if addiction is no longer required to be
part of their health plan.
Essential health benefits are called essential for a
reason, and all insurance plans should cover preventive care
and evidence-based addiction services, including the gold
standard, which is medication-assisted treatment. Block grants
should not replace insurance coverage because no disease can be
treated through grants alone.
We on the front lines know what works. We have done a lot
with very little, but this is a national emergency. We
desperately need new resources, not repurposed funding that
will divert from other critical priorities. These funds should
be given directly to communities of greatest need. Cities and
counties have been fighting the epidemic for years and we
should not have to jump through additional hoops, like
competing for grants and having funding pass from the States to
cities. That will cost time and more lives.
Our third approach is to reduce stigma and prevent
addiction. We have trained all of our nurses in our 180 public
schools to save lives with naloxone and we now have addiction
and mental health services in 120 of our schools. Opioid
addiction affects those even younger. More than half of
children who die in Baltimore have a parent or a caregiver with
addiction and mental health concerns. Home visiting for
pregnant women helps to identify families in need of treatment
and support. This is a key component of our citywide strategy,
B'more for Healthy Babies, which has successfully reduced
infant mortality by nearly 40 percent in 7 years. The opioid
crisis requires proven public health approaches spanning the
entire life course.
In closing, we know what works. We need support from the
Federal Government with three actions. First, protecting and
expanding insurance coverage to get to on-demand treatment for
the disease of addiction. Second, allocating additional funding
to areas hardest hit by the opioid epidemic directly to local
jurisdictions. And third, supporting early interventions for
women, children, and families. By the time this hearing is over
at least 10 more people will have died from overdose. I urge
Congress to commit the additional resources needed to save
lives and reclaim our communities.
I thank you for calling this hearing.
[The statement of Dr. Wen follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Rokita. Thank you, Doctor. Dr. Cox, you are
recognized for 5 minutes.
TESTIMONY OF DAVID COX, SUPERINTENDENT, ALLEGANY COUNTY
Dr. Cox. Good morning, Chairmen Rokita and Guthrie, and
Ranking Members Polis and Davis. Thank you for the invitation
to be here today to share the very deep impact of a real
struggle affecting our district, students, and our community.
As stated, I am the superintendent of schools in Allegany
County, which is located in western Maryland, where it's been
my honor to serve as its superintendent since 2009.
Just a few quick facts about Allegany County. The median
income is just over $40,000. The population there is about
72,000. Our current student enrollment is 8,700. Our free and
reduced meal population in the school system is 55 percent.
Countywide, our special education population is 16 percent. And
according to our sheriff this year to date there have been 27
overdose deaths in our county. Last year there were 59.
Today I want to share the impact of opioid abuse that
affects my students each day and the dramatic change that I've
witnessed in just the past 5 years, and with each successive
year getting progressively worse.
One of the first was a decline in our attendance and
parental involvement in the child's schools. We work very hard
as a priority of our local board to provide every child in our
county with a high-quality preschool experience in our district
and to identify the learning needs of children as early as
possible. In doing so, we've experienced a sharp increase in
the number of children who require special services due to the
opioid issues.
Eighteen percent of all newborns in Allegany County are
born drug affected. And this statistic does not include those
children who may have prolonged prenatal exposure to alcohol.
Last year we experienced multiple occasions where parents
overdosed and died in their homes while their young children
were present. On two different occasions during the preschool
home visits our staff encountered young children who answered
the door, and each of those times when asked where their mother
is the child said she's asleep. And when further investigated
one of the mothers was deceased and the other was brought back
through the use of Narcan.
In one particularly sad and impactful occasion last school
year we had a kindergarten student who came to school on a
Monday morning after staying with her father over the weekend.
When she got to school she was sick and she had a fever. The
school nurse tried to call the mother since the custody
schedule indicated that the mother was the Monday caregiver.
When the mother did not answer the phone, the school's
secondary emergency contact was her grandfather who was
contacted and he picked her up for medical attention. No one
could have imagined that this child's mother and the mother's
boyfriend had overdosed in the mother's home, at which time the
boyfriend's also 5-year-old son was in the home and not in
school. When the little boy ran out of food in his home he went
to neighbors' houses and knocked on doors for food, which led
to the discovery then that the little girl's mother and the
boyfriend were dead from an overdose of fentanyl. It was
estimated by our authorities that the mother and boyfriend had
been dead for 2 days.
My elementary principals have shared with me this year that
they're experiencing more and more incidents of children who
have severe behavioral issues when they enter school. Some of
our preschool age and kindergarten students require full-time
adult support just to manage their behavioral issues as they
work with individual behavioral support plans and often there
is limited parental support.
The good news in all of this is that for many of our
children who have been so impacted their public school is the
place that they are the most loved, the best cared for, and
where they receive the best nutrition, they're the warmest, and
where they're shown the most kindness. And for this I am
grateful to our caring teachers and schools and staff members,
where they can grow and learn.
Allegany County Public Schools has revised its health
curriculum to include specific information for students
regarding substance abuse at all grade levels. We have
particularly focused on the high school level on the prevention
of opioids where we have enlisted the help of two recovering
opioid addicts who give presentations to students in high
school health classes. All schools are now stocked with
naloxone and staff members know how to administer the opioid
antidote to persons who are believed to have overdosed.
While I do appreciate that President Trump has recently
recognized opioids as a national crisis, it is my hope and plea
that our Federal Government will allow flexibility in use of
Federal funds to allow school districts to utilize resources to
help with our efforts to combat this crisis and to tend to the
many unmet needs of our children. There is a good opportunity
that Title IV funds in the new ESSA regulations could provide
some of those flexibilities.
I have great difficulty in finding the words to describe
the magnitude of the unmet mental health issues and the health
issues of my students and families. Many are self-medicating
their depression and anxiety and many suffer from generational
addiction. Others have become addicted to prescription pain
medicine and migrated to opioid addictions. Others, our
children, are left with deep emotional scars when they lose the
parents due to overdoses and there aren't enough resources to
provide all the needs for counseling, therapy, and treatment.
Keeping options open for children's health insurance programs
is a critical need.
I want to express my sincere appreciation and opportunity
to be here today. And if there is anything that I can do or
AASA, we would certainly be glad to have you contact us.
[The statement of Dr. Cox follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Rokita. Thank you, Dr. Cox. I appreciate all the
witnesses' testimony.
I would like to recognize the chairwoman of the full
committee, Dr. Foxx, for 5 minutes.
Chairwoman FOXX. Thank you, Mr. Chairman, and thank you for
convening this hearing. It is a very, very painful topic to be
talking about, but it is one that I know we need to discuss.
Mr. Robinson, in your testimony you talked about workforce
preparedness and helping to educate people. How does preparing
and educating individuals to reenter the workforce increase
their motivation for treatment?
Mr. Robinson. Vocational education is a part of a continuum
of care for addiction treatment. It drives greater levels of
success for really three reasons. One, when someone enters
treatment and knows there is a second chance career path it
inspires hope and increases treatment motivation. Number two,
the twelfth of AA informs us that sharing our recovery is one
of the foundations of long-term sobriety. So this concept
suggests that finding purpose in helping others strengthens
your own recovery. And then, finally, and I think most
importantly, experiencing the dignity of work gives recovering
addicts who have reentered the workforce a positive self-image,
confidence, and helps them to establish career goals and a plan
for their future.
A great example of this is Vanessa Keeton, who was an IV
heroin needle user who entered one of our residential treatment
centers and completed our internship program. She later became
a treatment center director while earning a college degree and
purchasing her first home. And recently she resigned as our HR
director and now started a business that is supporting her
family.
Chairwoman Foxx. Thank you very much. And thank you,
particularly, for mentioning the dignity of work. I don't think
we do that often enough in our conversations.
Ms. Miner, you discuss how families need to be part of
their own solution. Can you elaborate on what this means? And
my assumption is it is different for different families, but
you might want to give examples of that.
Ms. Miner. Absolutely. Families are different, they are
unique in their own ways. Really, in my position in Colorado, I
sit down with the families and discuss with them what it looked
like for them when things were going well for them, before
their addiction had taken its toll, what their children looked
like, what kind of supports they had in their family. Because
all too often we find that when someone is in active addiction
that they have really severed their ties with all of their good
supports in their life. And they really believe that this is
severed for life. I share my story with them and tell them
about how bad I had hurt my own mother through my addiction and
she is now my best friend again and my biggest support. And
really we have got to get these families to believe that they
have the power within themselves to do it.
Chairwoman Foxx. Thank you very much. Dr. Cox, I represent
Alleghany County in North Carolina but we spell it just
slightly differently, we put an ``H'' in it there. And our
county is not as large as yours and I don't think it has quite
the same problems, but I love representing Alleghany County in
North Carolina.
You discussed the need for flexibility for the use of
Federal funds to allow schools districts to utilize available
resources to help meet the needs of the students. How would
additional ESSA Title IV fund flexibility help you as you
respond to this problem?
Dr. Cox. Well, let me give you a very specific example. And
I go back to a meeting I was in yesterday with my elementary
principals. It was our regularly scheduled time and we talked
about some of these issues and the presentation of kids with
lots of needs. In our district we have one behavioral
specialist that serves the needs for all of my 13 elementary
schools. While I am grateful that we have the Title IV funds,
you basically have to write your plan to fulfill three
different areas. And in our county we get $70,000. And it would
be helpful if I could pool all of that money to be able to hire
another behavior specialist to help with my elementary
principals and the counselors and the nurses in the school to
design plans to deal with the behavioral issues. I mean, that
is one example.
And I think, you know, in all of our public schools in
Maryland, across the country, having greater flexibility within
the Federal entitlement programs to meet the specific needs in
each of our jurisdictions would be very helpful to all of us.
Chairwoman Foxx. Thank you. And thanks to the panelists,
again, and thank you, Mr. Chairman, for indulging me. I yield
back.
Chairman Rokita. I thank the chairlady. I recognize Ranking
Member Scott for 5 minutes.
Mr. Scott. Thank you. Thank you, Mr. Chairman. Mr.
Chairman, it seems to be a consensus that we should treat the
opioid addiction through a public health strategy rather than a
criminal justice strategy, which means primary prevention
before people get in trouble and then responding afterwards.
Dr. Wen, you mentioned in your closing statement a need to
support early intervention for women, infants, and children.
What does that mean and what can be achieved?
Dr. Wen. Thank you for that question. We need to have early
intervention and detection. That would include things like home
visiting services, which have been found to have profound long-
term effects on improving children's health and also the health
and wellbeing of their families, too. We know that there is a
cycle that exists, this cycle of poverty, trauma, addiction,
that addiction often begets addiction. And we need to do
everything we can to break that cycle, to have early
intervention where possible, to have prevention services, but
also critically, when people are seeking treatment we need to
be there for them. We should not have to tell them to wait
weeks or months, but we should make every interaction the
opportunity for intervention.
Mr. Scott. Well, if you are going to have a public health
response as a cost after they get addicted, to paying for the
services, can you repeat what you said about the effect of cuts
in Medicaid and removal of behavioral health coverage as an
essential benefit in health policies?
Dr. Wen. Absolutely. In Maryland alone there are 250,000
people who gained insurance because of expanded Medicaid. All
these individuals could stand to be without access to treatment
if Medicaid were cut. Essential health benefits, too. One out
of every three individuals who now are newly insured through
ACA plans might not have gotten coverage before because
essential health benefits did not include addiction services.
For all these individuals there is no margin of error. So an
individual who is in treatment now, if they don't have
treatment tomorrow their only option may be to overdose and
die. And at a time of a public health epidemic the last thing
that we can afford to do is to deprive people of the coverage
they have instead of providing access to treatment for the more
than 1 in 10 who cannot access it now.
Mr. Scott. You made a comment about dealing with the
supply. Can you say why investments in cutting supply are
inherently unsuccessful?
Dr. Wen. Well, currently substance abuse already costs
society $600 billion annually in medical costs and
incarceration costs. So we need to invest much earlier. And
cutting supply alone is not going to work unless we also
address demand, because currently we have millions of people
who have the disease of addiction. If we are not able to get
them treatment, that demand is going to continue to fuel supply
and that is why a public health approach combined with a law
enforcement approach are what we need. That is the humane thing
to do, the ethical thing to do, and it saves society money.
Mr. Scott. Thank you. Dr. Cox, you indicated that
superintendents need flexibility with the funding. Isn't it
true that superintendents have also been asking for significant
increases in funding, particularly Title II-A funding, and
other funding that can help address this? Not just flexibility,
but more resources?
Dr. Cox. We have a lot of needs and certainly additional
funding would be helpful. One of the greatest needs is that for
treatment, that we have children whose mental health needs are
not being attended to because there aren't enough resources to
do that.
Mr. Scott. And so you need more resources, not just
flexibility?
Dr. Cox. Yes.
Mr. Scott. Thank you. And, Mr. Chairman, I yield back.
Chairman Rokita. I thank the ranking member. I recognize
myself for 5 minutes. I thank the witnesses again.
Mr. Robinson, you mentioned Alcoholics Anonymous, and
pardon my ignorance, does it receive Federal funding?
Mr. Robinson. No, it does not.
Chairman Rokita. So that allows you to explore the
spiritual element of the recovery process?
Mr. Robinson. Yes, absolutely. And, again, you know, in our
treatment centers we still have an addictionologist leading our
medical programs. We are nationally accredited by CARF, so we
are recognized as a center for clinical excellence.
But we have added two things to our programs that maybe not
all programs have, and one is a spirituality program, which is
very, very important, especially when you start looking at
pastoral care and chaplains. And that is very consistent with
other faith-based health systems that we have across the
country.
And then, finally, as I said in my comments, we have added
vocational workforce development as a key part. And so you
really have to treat the whole person and spirituality is a
piece of that.
Chairman Rokita. And funding source aside, and regardless
of it, you recommend spirituality and vocational for every
program?
Mr. Robinson. Absolutely. I think we should be investing in
programs that are holistic, that are treating the whole person.
Addiction devastates every aspect of someone's life.
Chairman Rokita. Thank you, Mr. Robinson. And then you
mentioned Medicaid-eligible healthcare providers. Can you
unpack that a little bit?
Mr. Robinson. Yes. I mentioned the peer support specialists
in our State is a Medicaid billable professional, which is
incredible public policy because it creates employment for
people recovering from addiction. And it puts them to work in a
field that is the best thing for them to do, which is to share
their recovery with other people. And so in our State, for some
billing codes, a peer support specialist, who is someone who
has been clean and sober for a year, that has either got a high
school diploma or GED, that goes through a 40-hour course, they
become a behavioral health practitioner. And organizations like
ours hire those individuals to lead group, to do individuals,
to go to needle exchanges, to go to ERs----
Chairman Rokita. And what is the cost to get them trained--
or educated, excuse me, so that they are Medicaid billing
eligible? Roughly.
Mr. Robinson. So it is a 40-hour cost and our academy has
added lots of other skills. Our Workforce Development Board
provides us approximately about $10,000 for each one that we
train. But we are training super peer support specialists that
are certified in CPR, first aid.
And one of the other things about peer support specialists
is it prepares them--when they start getting this medical
training they can go into other careers other than peer
support, enter the nursing field or other healthcare
professions, like medical assistants.
Chairman Rokita. Thank you, Mr. Robinson. Let me skip over
to Dr Cox here. You mentioned, I believe, if not in your oral
testimony, your written testimony, community task forces?
Dr. Cox. Yes.
Chairman Rokita. Can you unpack that a little bit?
Dr. Cox. Sure. We have several----
Chairman Rokita. How do you organize them? Who is involved?
What is the cost associated with it? What is your funding
source if there is a cost to the county?
Dr. Cox. We have several actually. The Western Maryland
Health System sponsors one and they are called actually The
Summit. And they are the recipient of some State grant funding.
Chairman Rokita. Summit?
Dr. Cox. The Summit, right.
Chairman Rokita. Okay.
Dr. Cox. I am a member of the Greater Cumberland Committee
Education Workforce. They also had an EVANA forum. And then we
have staff members who participate in various committees with
the health department. We have a lot of efforts underway. Our
sheriff, as a matter of fact, this evening will kick off
another series of town hall meetings all over the county. So we
have done a really good effort of educating the population
about what addiction is.
Chairman Rokita. What is the effect so far? Can you tell?
Dr. Cox. Well, I think we are a lot better educated as a
community about the aspects. I mean, for example, just
educating people who have no experience with addiction, that
people use to feel normal. That is one of the hardest things I
think for people to understand is that a person doesn't use
necessarily to get high, but just to feel normal so that they
can carry on and function. So that is one of the things that we
have----
Chairman Rokita. Thank you. Thank you, Dr Cox. Coming back
to Ms. Miner now. You indicated in your testimony--and thank
you for sharing your tragic story as well. I appreciate the
courage that must take. You mentioned that you thought you
weren't affecting your kids, perhaps they didn't even know, and
then obviously you say you now have children that are or were
drug addicts. So they did see your behavior? What do you think
the cause is? Is it just more than observation? Or what is your
instinct as a mother there?
Ms. Miner. They did see. They saw that I was not present.
They saw that when they needed me to wake up in the morning to
take them to school that I could not do it. They saw that when
they were clinging on my leg wanting mommy time that I could
not be present because----
Chairman Rokita. Why does that make them become a drug
addict in your mind?
Ms. Miner. You know, I really believe--and after talking to
both of my daughters, that because they witnessed so much
tragedy in their life and because there was so much trauma that
was never dealt with them. When I first got clean everyone
swooped around me because I was pregnant with my son, but
nobody helped my daughters who had suffered significant trauma.
And trauma is a leading cause to substance abuse.
Chairman Rokita. Thank you. At the risk of breaking my own
rules I need to stop. I apologize. Thank you very much for your
responses.
I now recognize the ranking member of the K-12
Subcommittee, Mr. Polis, for 5 minutes.
Mr. Polis. Mr. Robinson, can you confirm if your centers
accept Medicaid and receive Medicaid reimbursement for
services?
Mr. Robinson. We do.
Mr. Polis. Okay. I just wanted to be clear to point that
out as a Federal funding stream.
Ms. Miner, you know, I think the power of your personal
narrative is very strong. Do you have any suggestions about
what we can do either officially as a committee or unofficially
as individuals to encourage more people like yourself to be
open and share their own stories and narratives and help
educate others?
Ms. Miner. I really believe that people like myself can
help to build the power of people in recovery up to want to
come and talk. It is a very frightening thing to go out and
share your story because you never know the reaction that you
are going to get from people. We are our own worst critics and
we tend to think that everybody that we go and talk to is just
going to look down on us. It is really about educating us and
really helping us to get our voices out there and for you to
really want to listen, and for us to know that you want to hear
what we have to say.
Mr. Polis. And, you know, I have also appreciated the
movement that many families who have lost children or family
members to the opioid epidemic have been more forthcoming in
their obituaries to mention the true cause rather than sweep it
under the rug. The more visibility and awareness I think the
more empowered we are to counter this deadly epidemic.
Dr. Cox, I want to thank you for being here today and
sharing some data about the opioid crisis. In your testimony
you talked about the funding struggles that your district is
facing. In Colorado, when I meet with superintendents and
school board members, often funding is one of the first issues
they bring up. Still, school districts are being asked to do
more with less. And we have never met through this body our
full commitment to special education funding.
Most recently there is significant scale-backs in funding
for ESSA. For instance, eliminating Title II has been proposed
and cutbacks in Title IV Part A. Can you share the importance
of fully funding Federal education programs, specifically Title
IV, and how this could benefit Allegany County Public Schools
in your efforts to support students and families impacted by
the opioid epidemic?
Dr. Cox. Sure. You are correct. I mean, we have so many
needs and this opioid crisis has only contributed to that. And
we are funded by a combination--and every State is a little bit
different, but most of our funds come from the State of
Maryland. Second is going to be our local county government,
and then the third pool is the Federal funds. So we use a
combination of all those funding sources to meet the needs.
And, as you mentioned, with IDEA not being fully funded it
really imposes some hardships. And this issue impacts the IDEA
needs that children have. So it is only going to create more
need for children. So, you know, whether it is additional
funding for IDEA or Title IV flexibilities or additional Title
IV funds, we just need more resources to deal with the issues.
Mr. Polis. And, Dr. Wen, I want to thank you for being here
this morning. I am fortunate to represent a district with
several research universities, University of Colorado at
Boulder and Colorado State University, both of which are
leading research universities doing great work to help better
understand the opioid epidemic. In a recent study from CU in
partnership with the VA in Colorado they found that patients
almost universally cited emotional support from family members
and healthcare providers as essential to recovery.
Can you speak to the emotional support for family members
and healthcare providers, and specifically what Baltimore is
doing to help provide emotional support services for patients?
Dr. Wen. It is critical to remember that when people are
recovering from the disease of addiction they need not only the
medication assistive treatment, which is also the gold
standard, they also need psychosocial counseling and wraparound
service, social services. And also that people who are addicted
to opioids are not only treating physical pain, they are
potentially treating some other type of pain as well that might
include emotional pain and trauma.
And so in Baltimore, we provide services for healthcare
workers. We provide services also to assist with our most
vulnerable, including our children in our schools.
Mr. Polis. And are those models--do you think they can be
expanded or scaled, included in rural areas?
Dr. Wen. Absolutely. We have many evidence-based pilots and
evidence-based programs in Baltimore. We know what works. We
just need the resources to scale them up in our jurisdiction
and across the country.
Mr. Polis. And I will finally go back to Ms. Miner. Can you
share a little bit about your personal experience as an
advocate working across different systems and different
jurisdictions that are all trying to work on this issue and how
you have been able to try to bring people together through your
own personal narrative and advocacy?
Ms. Miner. Absolutely. We are still very siloed, I am
finding out, across the country, but I am finding more and
more, at least in Colorado, that people are wanting to work
together. They are wanting to talk so that we can help
eliminate the trauma to the family from the family having to
tell their story over and over again because every time they
have to repeat it is more traumatizing to them and to their
children. And with me working so closely with the executives
that we have in Jefferson County, it makes it that much easier
for me to help them partner with each other and with the
families. And they really want to listen to what the families
have to say.
Mr. Polis. Thank you. And I yield back.
Chairman Rokita. The gentleman's time has expired; the
gentleman yields back. Chairman from Kentucky is recognized for
5 minutes.
Chairman Guthrie. Thank you very much. It is great to be
here. And I just want to say that this is something that is not
going to be solved solely in Washington. Certainly you guys are
on the front line at the local level. I just want to point out
for the witness testimony earlier, joining us was Kim Ozer from
northern Kentucky, which is not just the north part of our
State, northern Kentucky is how we define our Cincinnati
suburbs. So if you live in northern Kentucky, you are closer to
a Reds game than if you live in north Cincinnati.
And though hearing opioids has been statewide, we call the
I-74 corridor in Appalachia, where you are, has been really the
brunt of it and all the work moving forward. And there are so
many issues and there are so many committees here looking at
this crisis together. But on the Higher Ed Committee that I
chair, we are really looking at how the opioid crisis is
affecting the workforce.
So I did my 21 town halls in August. Everywhere I went most
were talking about healthcare, but there was not one that
people were not talking about the heroin problem and opioid.
They say heroin back home, but we are talking opioids in
general. And so it is everybody who is focused on it want to
move forward, but every employer that I would talk to who were
looking at--I think every employer I talked to in Kentucky--you
will probably find some rural areas, but probably in your area
that is not--are looking for people to hire and the biggest
problem they are seeing is passing the drug test, a lot of
people who show up to work. So there are a lot of issues that
we just can't look at the criminal justice problem, we have got
to look at it holistically. I don't want to dismiss that part
of it. I have changed my attitude on that, too, is that we have
got to look at people are in trouble because they are addicts,
not the other way around.
So the big thing is, as you said, I think you hit it, the
dignity to get them to work. And I know your program does that.
And so what are you hearing from local businesses? And I know
that you tailor some of your programs from what local
businesses have told you they need to get certificate programs.
Could you address that? Mr. Robinson? I am sorry, I am talking
to you.
Mr. Robinson. Our first training was to provide peer
support specialists for the addiction treatment field. And
those folks are going to work not only for us, but for other
providers, community mental health centers, hospitals, health
departments.
One of the things that has recently happened to us is we
had an executive with a major industrial maintenance company
approach me. I was actually just eating in a restaurant in our
town and he said we are needing to hire people. We can't get
enough folks to pass the drug screen, and especially we need
welders. So we are right now in the process of adding a welding
program to what we are already doing and that is going to allow
us to create a flow not only of an opportunity to allow someone
that is recovering from addiction to maybe start a job at
$40,000 or $50,000 a year, but it is going to provide a flow of
employees who are in some ways kind of drug-proof because they
have been through treatment, they have got the support.
And, again, that dignity of work, the confidence that
comes. One of the most compelling stories I heard was one of
our graduates came by my office, it was such a big deal, to
tell me that he had just been to the social services office and
told the worker there to take his kids of Medicaid because he
had private health insurance. And that worker said it is the
first time they had ever seen that. But I could see in his eyes
just tears welling up when he was able to come and share that
with me and came to my office to tell me that.
Chairman Guthrie. That is great. And I know Sullivan
University out of Louisville is partnering with you so people
can also earn credentials, academic credentials, with your
training program. How does that work?
Mr. Robinson. Sullivan has been a great partner. And they
are just one of our most outstanding private universities in
the State, including having a pharmacy school. And so they just
came along and said, look, we have got a responsibility as an
education provider to be involved in this issue in our State.
And they came to us and said how can we be involved? And so
they stepped forward, and at their own cost are awarding
college credit for our peer support academy. Those folks are
not having to pay any tuition dollars. They are awarding
equivalency credit, which is fantastic.
And now we have got other educational groups, like our
community college system, who is coming to us and saying we
want to do the same thing Sullivan is doing. And, again, this
idea of putting vocational workforce skill-building as a part
of the treatment continuum, we have never seen anything
increase the outcomes of our treatment programs better than
this.
And, like I said, the first graduating class of our peer
support specialist academy we graduated 16; 14 of them today
are full-time employed, they are sober, and they are 18 months
at least clean and sober, so that is 85 percent. That is an
incredible return. And I think we can do that in all kinds of
different professions.
Chairman Guthrie. Well, thank you. I appreciate that very
much. And I don't have enough time to ask another question, but
I was going to ask Ms. Miner just about working with families.
But I just want to say when you guys share your stories that
has got to be extremely difficult to do and put your family out
here as you have already done earlier today. But it means a
lot. I think it adds to what we are trying to do and it
certainly encourages other people and I appreciate you doing
that, all of you who shared your personal stories and the work
you do.
And my time has expired. I yield back.
Chairman Rokita. The gentleman yields back. Ranking Member
Davis recognized for 5 minutes.
Ms. Davis. Thank you so much, Mr. Chairman. And for the
record, I wanted to put in this State Health Reform Assistance
Network article, ``Medicaid States: The Most Powerful Tool to
Combat the Opioid Crisis.'' If I can put that for the record.
Chairman Rokita. Without objection.
Ms. Davis. Thank you very much. You know, I don't think any
of us could sit here with your very compelling testimony and
not be moved, not be concerned, and on some levels a little
outraged as well that we are not finding our way to provide the
resources that are needed to spot--you know, with all the
compelling good work that is being done in our local
communities. Because I think the local communities are the
foundation of how we respond. But we can't do that if we don't
have the resources. And so it is very important. We are doing
that in the context of contemplating trillions of dollars'
worth of debt that we are taking on right now, knowing that as
the years go by into 2025, 2026, the families who could be hurt
the most are those today that are really the most vulnerable
when it comes to the use of Medicaid and health and support
that is out there.
So, you know, I can't help but say that because I think
that we have to put this in some context. And it is wonderful
to have the sympathy, the empathy, the drive to change things,
but it is not going to happen if we don't recognize that we are
making choices every day here in the Congress. And the choices
that we are making today, unfortunately, I don't think are in
line with what we see as an emergency in our country.
And thank you very much for your being here because you
represent really the issue that we are facing today.
It was interesting to me, Mr. Robinson, as you were
speaking I could not help, but think of some of the issues that
we look at when it comes to the transition of our military into
civilian workforces. And some of the issues and the need that
we have had to have companies acknowledge and know more about
what they are bringing to the job, all the wonderful benefits
they bring in terms of knowing how to conduct themselves at
work, but also some of the trauma, in fact, that has been
experienced. I wonder whether you see that there is a link,
some relevance to that, and whether or not we could be looking
at some of those models as well? Does that align for you?
Mr. Robinson. Yes. As a grandson of a World War II veteran
this is something that is near and dear to my heart. I still
remember my grandpa wearing his DAV hat. And so he taught us to
take care of our military, whatever we can do.
So we have had several veterans come to us for treatment
because there still is a lack of access for those that are
coming back.
And one of the big success stories, one of the favorite
stories I love to tell, is Brandon Leslie, who was an
Afghanistan and Iraq veteran that came to us. He was an IV
needle user suffering from PTSD, went through our program, did
our internship program, became a residential staff, then a
center director, and now he is the assistant director over nine
residential centers, and he has only been clean and sober for 3
years. And so one of the things that I noticed were his
leadership skills that were just inherent in who he is that he
learned in the military.
And so we need more of our veterans that are struggling
active duty to get into recovery because he can talk to them in
a different way than anybody else can.
Ms. Davis. Mm-hmm. And I think that goes for Ms. Miner as
well. I mean, as someone who has been clean, as you noted, for
many years, you have that special gift to be able to
communicate that as well.
Dr. Wen, so within these discussions I think it is clear
that there needs to be a Federal response with the help of our
local communities. Can you say why is that important? Why can't
all of this just happen if communities did the right thing?
Dr. Wen. We are already doing what we can with extremely
limited resources, but I will give you an example. Because we
are out of money for Narcan, if we were to get money to
purchase 10,000 units of Narcan today I can distribute all
10,000 units by the weekend. Think about how many more
thousands of lives we would be able to save every day in our
local communities if we had the resources and the will to do
so.
The opioid epidemic is a solvable problem. This is what
frustrates me every day. We know what works, we know the
science is there, we just have to do the right things,
including protecting existing insurance coverage, but also
expanding coverage and increasing the resources to allow us to
do what we already know based on evidence works.
Ms. Davis. Thank you. Thank you, Mr. Chairman.
Chairman Rokita. Thank the gentlelady. Congressman Allen,
you are recognized for 5 minutes.
Mr. Allen. Thank you, Mr. Chairman. Appreciate you all
coming and sharing with us about this difficult, really
difficult problem that we have.
In this country it really dates back to the 10th century if
you read about the problems in China. I do not know how many
male citizens of the United States are on drugs, but in China
in the late 1800s over 25 percent of the male citizens of that
country were opioid users. And, of course, they went to great
lengths to deal with it there.
You know, when I am out and talking with educators, it is
difficult because a lot of our educators tell me their biggest
challenge, not only in elementary schools but also in colleges,
is emotional health of the student body. And, you know, I look
at my days in college and I thought that was a great time to
be--you know, I had a great time in college, it was a wonderful
experience. So I don't know what has happened since I was in
college. I know that I was fortunate in that drugs really did
not come on the scene until I was out of college, at least at
my particular college. But I saw it as soon as I got home after
college with a lot of my friends who I went to high school with
that became drug users.
I will tell you this, we have got 6-1/2 million jobs open
in this country right now. I did a 19 county tour in August and
I met with our chambers and our county commissioners and our
mayors, and economic activity is at its highest level. I met
with a company that is going to add 100 jobs in one county.
They had 400 applicants and only 40 could pass the drug test.
Folks, we have got a serious, serious problem.
I talked to law enforcement. In most of my counties my
sheriffs say that if we didn't have a drug problem they
wouldn't have anybody in prison. And maybe there would be
something else going on, I don't know. And a lot of it is
people have entirely too much idle time.
And so, you know, with that, Mr. Robinson, obviously
treatment is critical, but, you know, somehow--how do we stop
the supply? Because, like I said, if you read the history of
China when they cut off supply, the price, you know, increased
dramatically which stopped a lot of the use. Because right now,
as I understand it, opioids are very inexpensive. The street
stuff is very inexpensive to get. Do you have any comments on
that?
Mr. Robinson. I mean, I think we always have to be diligent
when it comes to attacking supply. One of the problems that has
happened with the prescription drug problem is that it is hard
to stop the supply when you have grandmas and people who in
their medicine cabinets have a 90-day prescription or a 30-day
prescription for oxycodone. And the opiates we looked at, you
know, 20 to 25 years ago are nowhere near as potent as it is
today. When you take a pill such as an Oxycontin table that
has--is supposed to release the morphine, the opiate, over time
and then you crush it and it gives you the full potency of
that, the addictive nature of that is just so much more than
maybe just the heroin that was available in the '50s and '60s.
The other thing is now we are getting these synthetic
versions, like carfentanyl and fentanyl, which are 100 and
1,000 more times more potent.
Mr. Allen. But again, that is a business decision by the
pushers to get more people addicted. I mean, you have got to go
to the source here and stop this.
Mr. Robinson. Yes, absolutely on the pharmaceutical
companies.
Mr. Allen. If we get serious we can stop it. I mean, the
country I think has got to get serious about stopping this
problem. I mean, you can't just say laissez-faire, we are going
to prescribe some byproduct. Now, obviously we have got to do
something with those folks who are on drugs, but until this
country decides we are going to deal with this and we are going
to deal with this in a way that we are going to stop it, I
don't know how we stop it. I mean, is there any disagreement?
You know, in other words, we have a very, very serious
problem here. And, you know, I am hearing, well, treatment and
throwing more money at it and this sort of thing, we have got
to stop--it is always the money. You know, in China, you know
who it was? It was the British that were making all the money
off the drugs. And so, you know, I wish you all the luck in the
world and I am thankful for what you are doing. Thank you so
much for what you are trying to do.
I yield back.
Chairman Brat. Thank you. I recognize Mr. Courtney for 5
minutes.
Mr. Courtney. Thank you, Mr. Chairman. I want to thank the
witnesses for your thoughtful testimony today. Again, and the
topic of the hearing which is to sort of even get beyond the
emergency, you know, first responder healthcare, but the ripple
effect that is happening in communities, which is true in New
England as well. A couple of weeks ago, I was with the school
superintendent up in Enfield, Connecticut, which is a suburban
town in Hartford County. It's about 50,000 population which
again in 12 days this year they had 13 overdoses, you know,
show up at the police and volunteer fire department. But the
school superintendent actually pulled out some data which was
actually pretty--it was even another layer of alarm because he
was describing what they are seeing in kindergarten in the
schools where, again, behavior is just totally unprecedented in
terms of what teachers and staff are seeing.
So, for example, they have the data, physical assaults in
kindergarten in the school year of 2013-2014 were 1 for the
whole district, there were 14 in 2016, last year's school year.
The emergency protective holds in kindergarten in 2013 were
four. There were 114 in 2016. And, again, the kids with
emotional disturbance--and I am going to submit this data for
the record, Mr. Chairman--but what it is doing to teachers is
that--you know, these are veteran kindergarten teachers who are
like at the end of the school day in tears because they are
just so overwhelmed with kids.
They have a term for some of the kids, they are called
runners, where they just literally bolt from the classroom out
the building, chasing them in the streets. And so, you know,
this has created a challenge that aside from everything else
that school superintendents have to deal with in terms of State
budgets and local property taxes, about how do you get some,
you know, stability under the roof of a school district.
So one of the things we did in this committee with the
ESSA, which was a great bipartisan achievement when signed by
President Obama, but a lot of the Republican members were there
at the White House, that updated the Elementary and Secondary
Education Act. We again really bolstered the Title II, Title I,
and Title IV funding that directed money to help schools, and
teachers in particular, to sort of get trained up to deal with
these behavioral health problems, which again didn't really
exist even as recent as 4 or 5 years ago.
And, Dr. Cox, I mean you have really talked about this
challenge that you are seeing with your staff. The Title II-A
funding that came out of this year's budget from the White
House and the majority is zero. And, I mean, that is the exact
opposite direction we ought to be going right now in terms of
what we are seeing because obviously we are talking about kids
in kindergarten. I mean, this is just the bow wave. This
problem is going to get worse as kids, you know, obviously come
in waves, you know, upcoming years as well as what their
behavior is going to look like as they go through the other
grades in the school system.
So, again, can you describe what you are seeing? I mean,
are you seeing teachers who are overwhelmed with trying to deal
with behavior problems that again are just unprecedented?
Dr. Cox. Absolutely. And, you know, I refer back to my
testimony. In meeting with my principals yesterday at our
monthly meeting, every time I meet with them and when I visit
schools that is what I hear. And just as an example of that I
hear stories, today we had this issue, and sometimes kids do
run. But the number of very serious discipline issues that kids
have just increased. And I will benchmark it in 5 years that I
have seen the sharp increase. And we have to hire additional
people just to be with the kids. We don't have the funding for
that. I mean, we have to take it from somewhere else. And so, I
mean, we have higher class sizes than we would like to because
you have got to do what you have got to do and we don't have
enough resources to do it.
Mr. Courtney. Well, what you just said is exactly what
Superintendent Drezek in Enfield described, which is that they
need social workers, they need help, but they are already
running into staffing challenges just in terms of having people
in the classroom.
And so, Mr. Chairman, I would like to introduce this data
from the town of Enfield for the record. And, again, I want to
thank the witnesses for really raising the alarm about the fact
that we are just dealing with the beginning of this problem,
not the end of it.
Thank you.
Chairman Brat. Thank you. I will recognize myself for 5
minutes and I will start with Ms. Miner and others can weigh
in.
Ms. Miner, do you have any experience or have children in
your programs who have experience with recovery high schools
and colleges?
Ms. Miner. Not in my experience, no, I do not.
Chairman Brat. Well, I will fire away and maybe you have
recommendations based on your work, and others can weigh in as
well.
The President's Commission on Opioids calls for better
educating middle school, high school, and college students with
the help of trained professionals, such as nurses, counselors,
who can assess at-risk kids. As you know, this epidemic does
not just affect older working Americans, it is affecting high
school and college kids as well. The President's commission
also calls for supporting collegiate recovery and changing the
culture on campuses, which I think is great. There is a
recovery high school in my district called McShin Academy,
where they are seeing great success just 1 year into their
program.
And so my question is, how can we focus on supporting
recovery high schools and colleges where those kids are having
great success? And, Ms. Miner, if you want to weigh in based on
what you may have heard about them, and others if you want to
weigh in as well.
Ms. Miner. Thank you. I really have not heard a lot about
them. I mean, it sounds like it would be something amazing
because opioid abuse is very prevalent in high schools, in
middle schools. I know my middle daughter, when she first got
into abusing substances it was prescription pills. And she was
in high school and then she had someone come up to her and say,
hey, try this heroin. It is going to get you higher, keep you
higher for longer, and it is more easily accessible and it is
cheaper. And then she went to that.
And we need to educate our kids. It is a must. They have
got to know the effects that the drugs are going to have on
them, not just that day, but long-term, and to be real with
them. I actually go and talk in different schools and I am not
going into the schools to tell the kids don't do drugs because
drugs are bad. I am real with them and I tell them this is why
you should not do the drugs, because you could wind up liking
them way too much.
Chairman Brat. Thank you. Any others want to weigh in on
that one? Mr. Robinson?
Mr. Robinson. I think one of the reasons that works so well
is because addiction is a disease and it requires treatment and
requires support. And so for kids in high school who go to a
recovery high school, that gives them that support they need,
to have a peer support specialist, the counselor. Same thing on
the college level. With all the temptations that are on typical
college campuses it would be a very hard place for somebody in
addiction to go and be successful. And not just in high schools
and colleges, but I think what we are doing, in taking
vocational workforce development to get people in addiction
straight out of treatment and then give them that vocational
rehabilitation and then prepare them for a job to go right to
work then, to produce people who can just reenter the workforce
instead of going back and selling drugs.
Chairman Brat. Right. Thank you very much. I am going to
ask a question for my colleague, Jason Lewis, from Minnesota.
And if any of you want to weigh in on this one. Question, it is
aimed at Ms. Miner again. Each of you has mentioned the
importance of coordinating with other entities and services in
the community. As part of the committee's work to reform the
Juvenile Justice and Delinquency Prevention Act we specifically
included renewed focus on community coordination of services to
prevent and address juvenile delinquency through the local
delinquency prevention grant program.
Ms. Miner, can you discuss why coordination of services at
the community as well as identifying and addressing any gaps in
services is critical to success for at-risk youth?
Ms. Miner. I believe that is really addressing the family
as a whole, not just the youth. Like we have said before,
addiction is a disease and it affects the entire family. So
when you are going in and you are working with these youth more
times than not what I have seen is that the addiction goes back
to the parents, back to the grandparents. So we are not just
dealing with this youth who is now getting in trouble.
Collaboration is a must. We have got to talk to each other
so that these families do not slip through the cracks so that
we can actually better educate them on how they can help their
whole family.
Chairman Brat. Okay. I would like to recognize Ms. Blunt
Rochester for 5 minutes.
Ms. Blunt Rochester. Thank you, Mr. Chairman. I first want
to really thank the panel, Mr. Robinson and Ms. Miner, for your
personal stories. You deeply touched me and I want to thank you
for that and also for the work that you are doing; Dr. Wen and
Dr. Cox for being on the front lines. I am a new member of
Congress and so to hear you reminds me again why we are here.
So I want to thank you all for that.
A few weeks ago, I had an opportunity to meet with neonatal
nurses in the State of Delaware, and we talked about neonatal
abstinence syndrome. And I wanted to go back to something in
your testimony, Dr. Wen. You said that you--in the testimony
you said the number of babies born addicted to drugs has
tripled between 1999 and 2013. Can you talk a little bit about
the long-term effects of neonatal abstinence syndrome on
children in their academic performance? And, also, has there
been enough funding or research in these areas to help us
understand the effects of NAS on children as they mature? And
Dr. Cox, you could also join in on that as well.
Dr. Wen. We are seeing a skyrocketing of the number of
babies who are born addicted to opioids. Many of these
children, many of these babies end up having severe problems
from the very beginning, including seizures and other
withdrawal symptoms that could be fatal. And many of them end
up having long-term effects as well, including reduced academic
performance. Again, emphasizing why it is that we have to
intervene as early as possible. And as early as possible means
that we need to provide treatment to women, we need to provide
treatment to pregnant women, and also to women before they get
pregnant, and in general to people because otherwise we are
going to be perpetuating the cycle where poverty and trauma and
violence and addiction ends up in another generation as well.
And I think this illustrates the necessity of early
investment of treatment of early detection and also of reducing
stigma. It is critical that we talk about addiction as a
disease, as everyone here has been talking about, because there
is treatment available, because we know that recovery is
possible. And unless we fight that stigma then people are going
to continue to have a disease that otherwise would be
preventable and treatable.
Ms. Blunt Rochester. Dr. Cox?
Dr. Cox. Sure. Dr. Wen certainly is in a better position to
address the medical aspects. And, again, we have about one in
five of our children born in our hospital who are drug
affected. And so we make an effort to reach out to them, but we
are only able to service about 11 percent of those identified
because it is voluntary. And some of the things that are
reported to me, the lack of executive function that the
children have and just creating very difficult issues that gets
to the learning, you have to approach that in such different
ways and that is one of the things that we struggle with.
Ms. Blunt Rochester. You know, the reason why I really
wanted to focus on that as particularly Ed and Workforce, we
are talking about not just high school and college students or
those who are older, but we are talking about babies and then
middle school, as you mentioned. And so it is sort of the
continuum. And I want us to think about how that impacts our
workforce, how that impacts the quality of life, healthcare. It
is all connected.
I wanted to ask, also, Dr. Wen, is there a national
standard of care for screening or treating NAS and how would
creating one help improve treatment for newborns?
Dr. Wen. We need to do a lot more when it comes to
addressing this issue, including with a national standard. But
I want to bring us back to how can we prevent neonatal
abstinence syndrome to begin with, which involves early
detection for pregnant women that includes increasing our home
visiting services so that we are able to bring women into
treatment and critically expanding treatment overall so that
everyone has access to live saving services.
Ms. Blunt Rochester. Thank you. Thank you, also, for
mentioning home visiting. I think that is one of the most
important programs and one that has been in jeopardy of many
cuts. And so again, I thank each of the panelists for your
testimony and I yield back.
Chairman Rokita. Thank the gentlelady. The gentleman from
Alabama is recognized for 5 minutes.
Mr. Byrne. Thank you. Dr. Cox, I have a question for you. I
am a former State school board member in Alabama and sort of
keep up with things. And I have heard, and it is very
disturbing to me, that a lot of our young athletes in high
schools get injured in practice or in a game, they go to get
treatment and their physician prescribes a painkiller, an
opioid, for them and they get hooked. And so I am hearing a
large number of our young people are hooked on opioids are
actually starting out getting a legitimate prescription for
pain drugs because of a sports injury, but then it just gets
carried away. I mean, either they don't understand what they
are on, then they get hooked and they start doing inappropriate
things to get more opioids. I don't know if you have had any
experience with that, if you have any views of what we can do
about that.
Dr. Cox. Sure. I think it is not just student athletes, but
any time someone presents at an ER or, you know, has a pain
issue, part of that according to--well, our western Maryland
health system has developed ER protocols and has tried to
educate ER physicians about pain management, and that certainly
is a problem. We have had students, unfortunately, that have
been prescribed opioids and it has become a problem. But it is
not limited to just our students. And that is an area that I
think is ripe for growth, too. We have in my opinion too many
prescriptions being written for opioids.
Mr. Byrne. I agree with you, it is bigger than athletes,
but high schools--athletes are playing on our sports teams, et
cetera, so I sort of feel like we have a little extra
obligation to be looking out for them. What can we do for with
our student athletes?
Dr. Cox. Well, I think it is an education effort. Maryland
has taken a lead in this. We actually have legislation that was
passed this year that addressed education efforts in high
schools. And we have--this is actually a copy of the opioid
awareness and prevention kit. So it is a good resource from the
Maryland State Department of Education. It is a part of our
health curriculum where we teach our children, you know, the
dangers of taking opioids when they are not absolutely
necessary.
So I think it is a two part. I think it is educating
physicians and folks as they present in ER plus educating our
kids through our curriculum and efforts to let them know ahead
of time the dangers, that when you take substances like these
they can be addictive. So we are addressing that way.
Mr. Byrne. Dr. Wen, you know, when young people, whether
student athletes or not, when they come to an emergency room or
come to a physician with a problem, they are young people, they
don't necessarily have the same judgment as an adult does and
they don't necessarily have the same knowledge of what an adult
does. What extra do we need to be doing working with young
people to help them understand, hey, this painkiller is not for
you to take forever? And you need to be careful that you find
yourself becoming too used to it and wanting to have it all the
time, describing to them. What is the obligation of the medical
profession with regard to this?
Dr. Wen. We know that there is an overprescribing of
opioids that is fueling this epidemic. And the CDC has put out
excellent guidelines for urging more careful prescribing and we
in Baltimore have been working with all of our doctors to
ensure that those guidelines are followed. Doctors also need
better tools as well. If opioids are the only tools that we
have for pain management, that is what we end up turning to.
But actually there are many other alternatives that we need to
be exploring. But I think you bring up a very important point
about what we do for young people because we know that what
works for children is not just teaching about saying no, we
also have to ensure that young people's lives are not ones that
they want to escape from. And that is why the early investment
and nutrition and family literacy and housing, all of these
other services are critical as well to prevent drug use.
Mr. Byrne. Now, I will just make this observation, and this
is not in any way an indictment of the medical profession, but
we come to you, we the nonmedical profession public come to you
when we have a health problem. We put ourselves in your hands.
Parents, we put our children in your hands. We have an injured
young person, you know that they are going to have a lot of
pain from whatever you are doing, you are using your
professional judgment as to what they should be taking to deal
with that pain. Maybe there is also an obligation on behalf of
the medical profession to spend a little more time with the
family and the young person saying, now wait a minute, this is
a very serious pain pill you are taking here. This is not
something for you to take lightly. Let us go over what you
should be doing and not doing with it.
So I just offer that observation, not in any way as an
indictment of your profession. But I think if we all work
together I think we can do something about this epidemic.
With that, I yield back, Mr. Chairman.
Chairman Rokita. The gentleman yields back. Ms. Adams, you
are recognized for 5 minutes.
Ms. Adams. Thank you, Mr. Chairman. And thank you all very
much for being here and for your testimony today. Mr. Chairman,
I want to enter into the record if we can a Time'smagazine
article regarding the President's desire to stop the opioid
crisis and the actions that don't match.
Chairman Rokita. Without objection.
Ms. Adams. Thank you very much. Let me direct this first
question to Dr. Wen. Do home visiting services like Head Start
and other early learning programs make an impact on the
outcomes for children in difficult situations? For example,
when a child suffers from trauma due to a parent's struggle?
Dr. Wen. Home visiting programs make a profound difference
in children's lives and in the future of their families. Home
visiting, for example, has been shown to reduce infant
mortality, to improve health for children. Home visitors might,
for example, find that there is paint that is peeling, that
there may be lead poisoning hazards in the home. Home visiting
also has been shown to increase educational outcomes for that
child as well as for the mother.
There can also be detection of other issues that come up
during home visiting, for example, on domestic violence, on
smoking in homes, on other traumatic instances for which there
are interventions that are possible. For home visiting to be
effective it must be fully funded. And not only is home
visiting itself important, care coordination is important, too,
because we also have to identify those families that are at
greatest risk in order for the home visiting to even occur in
the first place.
Ms. Adams. Thank you. Are there other ways and
opportunities to leverage early learning and early supports to
respond to the opioid crisis?
Dr. Wen. We need to be doing everything we can to invest in
our children in support for their family, recognizing that
things like housing are part of healthcare. Food and
nutritional support are critical to education and to health.
And recognizing this life course approach is important, too. If
a child is experiencing trauma because of substance addiction
in their families, what we have to do is to treat their
families and make sure that treatment is available at the time
that people are requesting. It just is not appropriate that
only 1 in 10 people who have the disease of addiction are able
to get treatment. We have to invest in treatment now because
that is also key to preventing the cycle of addiction from
fostering.
Ms. Adams. Thank you. Dr. Cox, the School Superintendants
Association, along with the Save Medicaid in Schools Coalition,
expressed a concern about how the American Health Care Act,
also known as the Trumpcare bill, would jeopardize healthcare
for the Nation's most vulnerable children. And the coalition
sent a letter urging Congress to avert the harmful and
unnecessary impacts that AHCA would impose on Medicaid.
So can you discuss the role of Medicaid in providing the
school-based health services in your county? And are you
concerned about efforts to cut Medicaid there?
Dr. Cox. Sure. In my district alone part of our funding
structure is we get about $2.5 million a year in reimbursables
for the medical services that are delivered to our children
while at school to meet their learning needs, and a lot of that
is through their IEPs. We have children that are medically
fragile, all kinds of different things. And AASA has taken a
position on that as well. I would just reference that about 50
percent of my children in my district do qualify for services
for the children's insurance healthcare, or CHIP. And so we are
concerned about that as well.
Ms. Adams. Thank you very much. Ms. Miner, thank you for
being here, thank you for sharing your story. And I appreciate
your comments on focusing on the whole family, which is the
approach that we need to take to address this addiction. We
have the jurisdiction over programs in this committee that
serve pregnant mothers all the way to programs that serve the
elderly. So we have that opportunity right here in our
committee to address those things.
Can you discuss why this holistic approach is absolutely
needed?
Ms. Miner. Sure. Addiction is a family disease. It does not
just affect the addict. We have got to serve the entire family.
We have got to go in and we have got to educate teen moms, we
have got to educate them when they are young. I have
conversations with my teenager and with my 8-year-old that are
in my home all the time about drugs and alcohol and cigarettes
and why they should not use them. And they carry this with
them. They go into school and they talk about it. They have
deep discussions with their peers at school. They go out in the
community and talk about it as well. It is really about
prevention and intervention with the families.
Ms. Adams. Thank you very much. And, Mr. Chair, I yield
back. I am out of time.
Chairman Rokita. I thank the gentlelady. Mr. Mitchell, you
are recognized. No, no, no, Ms. Stefanik, you are recognized
for 5 minutes. Excuse me.
Ms. Stefanik. Thank you, Mr. Chairman, and thank you to the
committee for having this hearing today to highlight such an
important issue. As we know, the opioid epidemic has wreaked
havoc across this Nation. I represent the North Country, which
is a district in upstate New York, and we have seen an
exponential increase in deaths related to the heroin opioid
crisis. And many of my local law enforcement, many of my
counties, many local advocacy groups have come together to
really foster these types of conversations in the local
communities.
My question, and I want to direct it to Ms. Miner to start
with, I have met with so many families impacted, whether it is
a recovering addict themselves, whether it is a parent who has
lost an adult child, whether it is healthcare professionals, or
whether it is principals and teachers. My question to you is,
yes, it is important to educate our youth about risks
associated with drug abuse, but I also think it is important
that parents, teacher, guidance counselors, employers,
managers, have resources and understand what the best practices
are so they can identify this early, early enough to help an
individual seek care.
Can you talk about what resources you wish you had and what
best practices there are out there?
Ms. Miner. I wish that we had more beds available. When Dr.
Wen had mentioned earlier about when a parent is ready and they
say that they are ready to quit, it takes a lot for a parent to
be able to come forth and say I can't do this anymore, I need
help. And then for them to be told we have nothing for you, you
are going to have to wait weeks or sometimes you have to wait
months, I have seen way too many overdoses because of the
parents that are waiting. They go back to what they know, and
that is the substance use to make them feel better.
We absolutely have to educate everyone that is involved
with this person's life, whether that be the schools, the
employers, the community resource centers, anyone who comes in
contact with this family, we have got to educate them and
really talk about what it might look like, you know, if little
Johnny is getting to school later and later, or he is missing
more and more school, could there be a problem. And how the
schools or whoever is coming in contact with this family can
approach that child without it feeling like it is an
interrogation or feeling like they have done something wrong or
that they are too afraid to tell on their parents.
Ms. Stefanik. Let me ask you about the flip side for a
parent being able to identify in their child, let us say a high
school age child--I met with a recovering addict who was a
nationally recognized athlete and had an injury. She went
through an operation and was prescribed pain medication. That
led to a downward spiral of addiction, in and out of jail. And
she was a very powerful advocate about how her--she was very
good at hiding it, she said. And her parents didn't know, her
coaches weren't aware of this issue. How do we educate the
parent in that situation, when the parent is not the addict,
but they are the parent of a child who is the addict?
Ms. Miner. I would say just we have got to break the stigma
about addiction. Everybody looks at addiction as a really bad,
dirty, ugly thing and they don't look at that it could be
something that is being prescribed, especially to our children
by our doctor, because we trust these doctors with our children
and they sometimes are the ones who are overprescribing our
youth. And it is really about educating the parents and sitting
down and talking to the parents about differences in what their
attitudes or their behaviors might be like, how they are
reacting to things. I know that in my own experience that when
my daughters had started in their active addiction their
behavior toward me changed. They became more aggressive toward
me and wanted to argue with me about a lot more things than
what they did prior to that.
Ms. Stefanik. And, Dr. Cox, if you could follow up from a
school's perspective, how do principals, teachers, coaches,
guidance counselors, how do we arm them with the resources and
the education they need to identify when a student is going
down the path towards addiction?
Dr. Cox. Well, again, it is part of a comprehensive
education effort and that is a part of our total health
curriculum that starts in elementary school where we talk about
this. And we have the DARE program at fifth and eighth grade,
but also it really gets intense in our high school health class
where we have actually recovering addicts who speak to our
students. Our sheriff comes in and talks about all the things
that he has seen. So we try to give them the best information
that we can so that they can at least be forewarned.
Ms. Stefanik. So the students are forewarned, but how about
teachers? Not the health teacher, but the average teacher in
the school, do they have the resources and the education they
need?
Dr. Cox. Well, let me give an example of that. You know, we
have made it part of our professional development. This year at
the beginning of school we convened an opioid panel of
community experts and we actually recorded that. So it has been
made available for our schools to use to show our teachers. It
gives them the facts and information. And then also----
Ms. Stefanik. Thank you. My time has expired. I am sorry
about that.
Dr. Cox. Sure.
Chairman Rokita. I thank the gentlelady. Time has expired.
Mr. DeSaulnier, you are recognized for 5 minutes.
Mr. DeSaulnier. Thank you, Mr. Chairman. And as someone who
has spent some time on this issue in the course of my public
service, I just want to remind folks some startling numbers.
The United States has 4 percent of the world's population, but
we consume 80 percent of the opioids in the world. Since 2000,
over 200,000 Americans have lost their lives to opioid
addiction. Four out of five heroin users started with the
opioids. In 1995, when OxyContin started, the abuse of opioids
was nonexistent. Quickly thereafter it became a catastrophe for
this country.
Ms. Miner, first to you. As the son of a parent who had
addiction problems, whose struggle was stigma and shame, I just
want to tell you how proud I am of your testimony and your life
testimony. In getting over stigma and shame in my relationship
with my dad, who was not as successful as you, he ultimately
lost his life to addiction, we have come a long way. But you
telling your story, but tell me what would have happened, do
you think, as you reflect back, if that child welfare worker or
public employee hadn't interceded the way he did, when he did?
Where do you think your life might be right now?
Ms. Miner. I think that I would probably be dead or in
prison. I really don't believe that I stood much of a chance
had I not had that one person that truly believed me and saw
something in me that I was not able to see in myself at that
time and to offer the supports to me for me to remain clean.
Mr. DeSaulnier. So to take something that is very emotional
and put it in that sort of actuarial perspective, and this goes
to cost and responsibility and prevention, intervention is what
we should be doing, but ultimately, Dr. Wen, as a physician we
want to get to prevention and root cause.
So there is a recent story, very troubling, in The New
Yorker, if it is true, it is titled ``The Family That Built an
Empire on Pain.'' It is about Purdue Pharma. My experience when
then-Attorney General Kamala Harris and I were working on
simply upgrading the prescription monitoring system in
California, which came to us by a software engineer who was a
constituent who lost two children who were hit by someone who
was abusing and doctor shopping, all we wanted to do was have
real-time information, so the Department of Justice, the
pharmacist, the doctor, could see if anyone is abusing. It has
been in effect now and it has worked. But it was obvious to me
that the pharmaceutical industry and the lobbyists in
Sacramento did not want that to happen. And I intuitively
thought that it was because they were making money on the lack
of our knowledge.
So in this article they talk about their senior medical
advisor, once publicly likening addiction of Oxycontin to
celery, where he said if you take celery--he said this at an
event at Columbia, talking about addiction and opioids--it is
healthy for you, but if you blend it and put it in your
arteries, inject it, it is bad for you. So in that article it
also talks about the response from Purdue Pharma is that
clients don't abuse it, drug users abuse it, which, Ms. Miner,
strikes me as throwing it right back on the addict. And
personal responsibility is also the people who sell this.
So could you talk to me a little bit about addiction,
prevention, root cause, and what the ultimate cause is, and who
pays for that?
Dr. Wen. We did not get to this problem of the opioid
epidemic overnight. There are a lot of people who have to take
responsibility, including me as a physician. I know that I
overprescribed opioids because that is what I learned in my
medical training to do. That is the culture in medicine that we
have to work to change. Big Pharma, though, plays a big role in
this as well. They had misleading advertising and perpetuated
this pill for every pain culture. If you fall down and you
bruise your knee, it is okay to have pain, you don't have to
take it away with opioids. There is a risk, there is a side
effect. That is something that we can all work to change today.
We have been talking a lot about education in schools. And
if you ask a student do you think heroin is good or bad,
probably they will know that heroin is bad. But when they see
their parent or their caregiver taking pills for back pain, for
dental pain, that is a culture that we also have to work to
change.
Mr. DeSaulnier. So, Dr. Cox, you talked about generational
addiction. So unlike tobacco, opioids we now know have addicted
future generations, and people have benefitted, just like the
tobacco industry, off of this addiction; not to ascribe blame,
but trying to identify responsibility to get at prevention.
Dr. Wen, back to you as a public health official. Unlike
tobacco, we need to go back upstream. If there was a settlement
agreement some years down the road, and I know that there is
litigation around the country from attorney generals, the cost
seems so out of proportion to the public cost of healthcare
around secondhand smoke.
Dr. Wen. We need much more investment and perhaps Big
Pharma can help us to pay for the effects of addiction that
they have helped to create.
Mr. DeSaulnier. Maybe they should be held responsible.
Thank you, Mr. Chairman.
Chairman Rokita. I thank the gentleman. The gentleman from
Wisconsin is recognized for 5 minutes.
Mr. Grothman. Yes, a couple of questions. As has been
mentioned, I don't know any child out there who gets through
school without knowing that opiates are bad for you.
Nevertheless, I would like--Dr. Cox said something before and I
would like follow up. You mentioned you had DARE and other
programs in your school system. Could you or anybody else be a
little more animated about what doesn't work? What are we
wasting money on so we can stop wasting money on it and
genuinely get people not involved in these opioids? Could you
give me examples of things that don't, so you can--anybody have
ideas of things that aren't working?
Dr. Cox. I think that is a hard question to answer. I mean,
you are talking about messaging to kids. And we don't really
have mechanisms to know how the messages have been effective or
not. It admittedly is a shotgun kind of approach.
Mr. Grothman. It is a little shocking. It is shocking. You
don't have any opinions on things that aren't working? I mean,
I have read articles on things that aren't working. None of you
up here knows things that are not working so we can stay away
from them?
Dr. Cox. Well, I will say I don't feel that anything we are
currently doing is not working. You know, specifically from our
DARE program we get lots of parental feedback on that, it
creates a great relationship with our law enforcement
community.
Mr. Grothman. You might want to Google DARE a little bit
and dig a little bit deeper.
Dr. Cox. I am aware of what you are speaking about.
Mr. Grothman. Okay. Next thing, I wonder if anybody could
comment on the criminal end of this? I know in my area, at
least in more liberal counties where a lot of the drug dealing
is going on, it is sometimes amazing how little the penalties
are and how people are getting off with very little. Does
anybody want to comment on what we could do on the criminal
justice side to maybe persuade people not to become dealers?
Anybody have any comments on that?
Mr. Robinson. I think one of the things to get people not
to be drug dealers, a lot of those--you know, if we have got
somebody that is part of a criminal syndicate, we need to
prosecute them and put them in jail. But most of the dealers
that we see are people that are dealing to support their habit.
So the best way to get those dealers not dealing is to put them
into a treatment program, give them a job skills course to
allow them to go back to work and have a different way to
support themselves than dealing drugs. And we have a lot of
petty drug dealers that are just supporting their habit.
Mr. Grothman. I am talking about Milwaukee because I am
from Wisconsin and obviously very, you know, ``liberalish'' and
maybe ``liberalish'' judges, ``liberalish'' DA. I wonder
whether around the country there is also a concern that there
are areas of high drug dealing in which people are not
receiving appropriate sentences. Given the huge number of
people who are dying does anybody feel that you have seen not
enough people being thrown in prison for, as a practical
matter, killing people?
Mr. Robinson. In Kentucky, we have broke our corrections
budget in most of our counties. The county executives, their
biggest cost that they are paying out is their jail budgets. I
toured a jail a couple of weeks ago that had twice as many
inmates as it was set up for because we have tried to
incarcerate ourselves out of this. And we have to treat and
then vocationally prepare people out of this problem.
Mr. Grothman. Okay. I will give you one more question,
because we are running out of time here. Are any of you aware
of any studies of people who go through this? I know it can
happen from any family, horrible things can happen in any
family. But on the family background of both the dealers and
the people who are, you know, arrested for possession, that
sort of thing, do we have any studies on that? Any indications
on, you know, where this disproportionately affects people?
Dr. Wen. We know that 8 out of 10 people who are in our
jails in Maryland use illegal substances. Four out of 10 have
mental health issues----
Mr. Grothman. No--okay. Mental health is a big issue and
what mental health issues are those?
Dr. Wen. It could be a combination of things, depression,
schizophrenia, anxiety. They are often coexisting with
substance abuse. And it is important for us to treat these
diseases as the diseases that they are because an investment in
public health is an investment in public safety. For every $1
invested in treatment, it saves society $12, including of
criminal justice and incarceration costs.
Mr. Grothman. Does anybody know any different on background
of these people?
Mr. Robinson. When it comes to IV needle users, which are
some of the folks that are most addicted, 80 percent of IV
needle users today had a childhood trauma that is linked to
their current issues. And so those early childhood traumas and
not dealing with that is a major----
Mr. Grothman. Can you describe trauma? Nobody knows what
that means? What is a childhood trauma?
Chairman Rokita. I think the gentleman's time has expired.
Mr. Grothman. Yes. Could you----
Chairman Rokita. The gentleman's time has expired. The
gentlelady from Oregon is recognized for 5 minutes.
Ms. Bonamici. Thank you, Mr. Chairman. Thank you to the
witnesses, value all of your testimonies but, Ms. Miner, Mr.
Robinson, thank you so much for being here and sharing your
very personal stories. It takes courage to do that in such a
public forum, but it really does make a difference.
I am from Oregon where, of course, this is affecting every
community, not just urban, but also rural communities as well.
In 2015, 180 people died from just prescription opioids in
Oregon. That doesn't include the nonprescription. I just had a
community discussion on opioids in Clatsop County, Oregon,
which is a pretty rural coastal community. My constituent,
Kerry Strickland, who I had met before, she created Jordan's
Hope for Recovery. She lost her son Jordan--it started with a
sports injury, following up on what my colleagues already
mentioned--after a 7-year struggle with addiction and relapse.
And her family's loss is just a reminder that we are talking
about, you know real people and how this affects people in
communities.
But there were some very common themes here about the
inability--and we had this roundtable--the inability when
people are ready, the inability to get them into treatment. And
there are just too many barriers. Like you said, we know what
to do, we just don't have the resources in many cases.
This crisis is tearing our families and communities apart,
but it is not the first time. We went through this back; it was
about 30 years ago, when the crack cocaine epidemic that
disproportionately affected marginalized minority communities
and, unfortunately, our country tended to respond with
increased criminalization of abuse and addiction.
And, Dr. Wen, thank you for recognizing, as others have,
that addiction is a disease, we should treat it as a disease.
We know that our response then affected an entire generation of
people and led to some pretty severe disadvantages and stalled
educational progress and poor academic, employment, and life
outcomes. So this is key, the conversation that we are having
today.
You know, the President just declared that the opioid
crisis is a public health emergency, but he didn't provide the
financial resources that we need to fight the epidemic. So we
don't just need a declaration. We need resources and we know
where they need to go: prevention, recovery, treatment. And by
bolstering the Affordable Care Act, for example, Medicaid,
fully funding the Every Student Succeeds Act, programs that
provide for health services for our students who are in schools
- this is all really important.
I just visited a school-based health clinic in a high
school in my district, and what a difference it makes for those
students to have somewhere right there on campus where they can
go, whether it be to talk to a counselor, get a vaccination,
get healthcare right there on campus. It really makes a
difference.
Dr. Cox and Dr. Wen, according to the original Adverse
Childhood Experience, ACE, study by the CDC, individuals with 4
or more traumas were 12 times more likely to have attempted
suicide, 7 times more likely to have alcoholism, and 10 times
at greater risk for intravenous drug use. And we know that
childhood traumas affect child brain development, children
living in households, as we heard from Ms. Miner, with
addiction are living in environments of chronic toxic stress.
So Warrenton-Hammond, which is a school district again in
Clatsop County, in my district, is helping students by their
incorporating trauma-informed practices into their school
system. They have shifted from a punitive to a compassionate
approach to school discipline, suspensions have gone down,
attendance has improved.
So, Dr. Cox and Dr. Wen, you know that teachers and our
school staff are oftentimes the first responders to the opioid
epidemic. So are there tools and resources that teachers need
to build around our knowledge of childhood trauma in order to
be good first responders? And I want time for other questions.
Dr. Wen. In Baltimore City, we have started trauma-informed
care trainings, including for all of our frontline city
workers, such as our teachers. We have done now trainings for
over 2,000 of our staff so far. It is important to shift the
mentality, not look at someone as the perpetrator of violence,
but rather as the victim of deep trauma. And that will help us
to break the cycle that we talked about.
We also have to increase mental health services and
substance abuse services in our schools, too. We have to
provide services exactly where they are. In addition to
recovery high schools, also increase services and screening
right in our schools.
Ms. Bonamici. Thank you. And, Dr. Cox, I want you to
respond to this, during Every Student Succeeds Act
reauthorization Congress authorized Title IV-A at $1.65 billion
because members on both sides of the aisle understand the
importance of these programs. Title IV-A is currently funded at
$400 million. Now, we have worked very closely with AASA, the
School Superintendents Association, of which you are a member,
to try to increase that funding. Isn't it important that
Congress uphold its promise to get that funding so we can get
these programs into schools?
Dr. Cox. Absolutely. It is the position of AASA that we
need the complete funding.
Ms. Bonamici. Thank you. It is not just the flexibility, it
is the funding.
And finally, I just want to close with a follow-up to the
DARE program. I certainly hope it has been updated from its
early '80s days because it was woefully ineffective. And I am
hoping that it is----
Dr. Cox. It has.
Ms. Bonamici. To an evidence-based program. Because there
are ways to figure out what works and what doesn't. And if it
is evidence-based that would be useful.
I yield back. Thank you, Mr. Chairman.
Chairman Rokita. The gentlelady's time has expired. The
gentleman from Indiana is recognized for 5 minutes.
Mr. Messer. Thank you, Chairman Rokita. I want to thank the
panel for your testimony today and for your stamina as we get
toward the end of today's hearing.
You know, in Indiana, opioids are wrecking communities and
breaking hearts all across our State. President Trump was right
to call this a public health emergency. And despite the hard
work of our police, first responders, public health officials,
and our schools, leadership all across these communities, the
epidemic seems to have only gotten worse. I think we all can
agree today that more needs to be done.
In Indiana, drug overdose fatalities have increased by more
than 500 percent since 1999. And estimates of the total annual
cost of overdoses exceeds $1 billion just in my home State of
Indiana alone. This crisis is crippling generations of Hoosiers
and ripping apart their families and their communities.
In Indiana, I applaud recent steps by our Governor, Eric
Holcomb, who in partnership with the Hoosier healthcare
providers are working to tackle this public health crisis.
Their approach is designed to decrease opioid deaths, increase
awareness, and decrease the number of babies born with neonatal
abstinence syndrome by devoting $50 million over the next 5
years to this problem in our State.
A couple of quick questions. First, I wanted to start just
with Dr. Cox. You gave testimony about some of the efforts in
and around your school. How do you train teachers to counsel
students who are coping with addiction themselves or who may
have a family member dealing with the disease?
Dr. Cox. Well, it is difficult. You know, I think part of
it is developing initial understanding of what it is because
there is so much misunderstanding about addiction. And so that
is what we have tried to do. And we don't have enough time
resource for professional development. That is an issue as
well. So it is not just the money issue in terms of the
professional development experience. But to answer your
question, you know, we need to help our teachers understand
what addiction is before they begin to help students and then
refer them to counselors.
Mr. Messer. And do you have family based programs, trying
to get parents more engaged as well?
Dr. Cox. We do. Again, our sheriff has done a really
remarkable job in the community holding town hall meetings
across the whole county. In fact, there is one this evening.
And they have been well attended.
Mr. Messer. Dr. Wen, I was hoping to just get any further
recommendations. I mentioned in my introduction Indiana is
working on a program to tackle these challenges. And I wonder
if you had any further recommendations as we get to the end of
this hearing for States who are looking to implement programs
to prevent deaths and increase awareness?
Dr. Wen. The first thing that we have to do is get
naloxone, the antidote, into the hands of every single
individual, not only first responders, but we should all be
able to carry it in our medicine cabinet, in our first aid kit,
in our schools, in our libraries, similar to how we have
defibrillators available at all these public places. But we
also have to have funding so that we can get this lifesaving
medication into the hands of everyone.
The second is we need to have treatment for people at the
time that they need, all types of treatment that are evidence-
based, which includes medication-assisted treatment that has
been shown to reduce illness and prevent overdose deaths.
And the third is we critically have to fight stigma and
encourage people to seek treatment. That also includes the
prevention that we all talked about.
We were speaking about schools and what we can do at our
schools. The Just Say No and programs such as that are not
going to be enough. The education for teachers will not be
enough unless we also promote wellbeing overall, so that we
provide children and families the support that they need in
terms of food and housing and other critical services.
Mr. Messer. I do have to say to that, quickly, that I grew
up in 1980s. I am a child of the 1980s and I remember the Just
Say No program. Frankly, I think it mattered. I mean, the 1980s
were a time when it wasn't cool to do drugs. Before that it was
cool to do drugs, After that, you know, some said it was cool
to do drugs. It wasn't cool then and I think it is part of the
answer, not the only answer. And I appreciate the rest of the
your testimony.
In the little limited time I have left, Mr. Robinson, I
would just ask you to maybe comment a little further on the
economic crisis that is being created by this opioid epidemic
as well. I have talked to so many employers in my home State
who are saying they are having a hard time finding the
workforce they need because drugs is epidemic in their
community.
Mr. Robinson. It is happening everywhere. And as I
mentioned in my comments, our State chamber CEO says the number
one economic concern in our State--and our State is moving
forward with economic development, but one of the big concerns
is are we going to, as jobs come, as companies expand, are we
going to be able to provide enough employees that can pass drug
screens? And that is why I think one of the places that we need
to look for workforce is people that are in addiction today. If
we can treat them, then put them through vocational
rehabilitation, and then get them a work ready program to put
them back to work, then we can provide those employees that
have been treated to those employers and meet this need.
Mr. Messer. Yes. Thanks again. Thanks for your testimony.
And thank you all for being here.
Chairman Rokita. Thank you, gentlemen. The gentleman's time
has expired.
Mr. Barletta, the gentleman from Pennsylvania, is
recognized for 5 minutes.
Mr. Barletta. Thank you. Mr. Robinson, you hit on exactly
what I am going to talk about right now. Whenever I sit down
with Pennsylvania business owners they tell me that a major
roadblock in job growth in recent years has been directly
connected to the opioid crisis. These employers have good
paying jobs that they desperately need to fill, but they can't
find people who can pass a drug test for hiring.
Now, Pennsylvania is not alone in this crisis. Economist
Alan Krueger identified national labor force participation for
men aged 24-54 has fallen more in counties across America where
more opioid pain medicine is prescribed. Chair of the Federal
Reserve, Janet Yellen, has also acknowledged the opioid
epidemic's tragic and devastating effects on the workforce.
Now, clearly there needs to be a plan of action to treat these
folks so that they could work again.
Mr. Robinson, in your testimony you shared how the CEO of
the Kentucky Chamber of Commerce identified addiction as
Kentucky's number one economic concern. What kind of
partnerships has the Addiction Recovery Center formed with
Kentucky workforce development boards to connect individuals
who can pass a drug test with employers? And do you have any
suggestions for how business owners in Pennsylvania and across
the country can find qualified individuals to fill their open
positions?
Mr. Robinson. I think our workforce development boards need
to be as involved in this opioid issue as the healthcare side
of this because treatment is essential. We can't get somebody
back to work without treating them, but we also have to be able
to give them an economic opportunity. And so I think the
workforce boards is the logical place for us to put funding
that allows them to work not only with treatment providers like
us and those that are doing workforce programs, but also to
work with those employers and to help us in this change in the
culture because there are a lot of employers that have zero
tolerance programs. Those zero tolerance programs are not going
to work in the current reality moving forward.
And so we need to get those employers to start hiring some
recovering addicts because then they will see what I have seen.
A third of my workforce is recovering addicts and they are my
best employees.
And so by getting those employers engaged--and we get them
to the table by saying, look, if you will give second chances,
we will help you with the programs, the workforce programs,
that you need to provide you with welders and truck drivers and
some of these high-demand fields, healthcare, that they are
suffering to fill those jobs.
Mr. Barletta. Yes, and I agree. And I think the first step
is getting help for people. So the public and employers and our
country as a Nation understand that it is a disease and an
illness. These are not people who are losers and decide they
want to wreck their lives with drugs. This is an illness, and
as a country we need to understand that. Get people help,
treatment, and then give them another shot at life.
Mr. Robinson. And we found as we have had people come into
treatment, stick around and do our workforce program, it is not
1 in 5 or 1 in 10. There is a significant number of people
coming into our residential centers. If given a career path at
the time of treatment and knowing that they are going to be
able to make a living on the other side of it, it increases
treatment motivation. And those become some of the most
successful people that we have in our communities.
Mr. Barletta. Well, the worst thing we can do as a Nation
is help people and get them treatment and then slam a door in
their face after they have gone through that when they are
looking for another chance.
Thank you.
Mr. Robinson. Absolutely.
Chairman Rokita. I thank the gentleman. The gentleman
yields back.
I would like to again thank our witnesses for taking the
time to be here with our subcommittees today.
I recognize Mr. Polis for closing remarks.
Mr. Polis. I want to thank our witnesses for being here
today and your compelling testimony, which will also appear in
the official congressional record for the benefit of members
who don't serve on this committee and members who were unable
to attend. Each of you shared stories and data about your work
and about the individuals that are impacted by the opioid
crisis.
In my own community, like for so many of us, the opioid
crisis has become very personal. For instance, my constituent
Carlos Santos. When Carlos was in high school he was severely
injured while playing in Summit County High School's homecoming
football game. During his recovery process, he was prescribed
habit-forming pain medications that later became an addiction.
For years Carlos kept finding the pills to continue his habit
until his entire life and health revolved around his addiction.
It took a serious drunk driving accident to finally give Carlos
a wake-up call that he needed to change his life. Now, years
later, Carlos has successfully battled his addiction. But we
all know that many others aren't as lucky and many pay the
ultimate price.
As policymakers it is important to hear and share these
stories, but we also have a responsibility to take these words
and turn them into action. Throughout this hearing we have
heard about how critical funding programs are for tackling this
national crisis. To truly defeat this epidemic we need to fully
fund programs that include the educational programs we have
authorized in ESSA that we have talked about today, mental
health and treatment programs; research to study pain
management alternatives like cannabis and others; and, of
course, fully fund and support Medicaid, which, of course,
provides funding to organizations like Mr. Robinson's.
I look forward to continuing to work with my Democratic and
Republican colleagues towards the goal of ending the scourge of
opioid and substance abuse across the country.
And I yield back the balance of my time.
Chairman Rokita. I thank the gentleman. Let me also add my
comments and close out this hearing. Again, thank each of you
for your leadership, your courage for coming here today and
helping not only these subcommittees and this committee as a
whole and this Congress learn more about this crisis, this
emergency, but your help to the entire Nation. You are, as has
been said in this hearing, on the front lines. And funding and
all that surely will continue to be discussed and debated.
But one thing is for sure that I learned in this hearing,
is that you are the solutions, we are the solutions as a
community. That one-size-fits-all approach certainly won't be
helpful to this coming from Washington alone. So thank you
again for your leadership.
Thank you for sharing your experiences with us. As my
colleague, who sat in the chair here for a while, Mr. Brat,
mentioned one of the bills we have been working to update--and
apologies we did not speak more about it in terms of how it
could help--is the Juvenile Justice and Delinquency Prevention
Act. Your testimony today highlights the need for reforms that
encourage community collaboration and engagement. And we have
done this in H.R. 1809. So this is just one example of how
Congress can be supportive, as the gentleman mentions, to
communities in responding to unique local needs.
Again, your testimony has been invaluable as we learn more
about how communities are coming together at the local level to
address this epidemic, and it informs our discussions as we
consider the next steps, including any legislation to help you
do your jobs better, be the leaders that you are.
So thank you again for everything that each of you do and
all the people that you represent who are doing very similar
work.
Hearing no other business before us----
Mr. Polis. Mr. Chairman, I do have a unanimous consent
request. I ask unanimous consent to insert in the record a
letter discussing the importance of the Medicaid expansion
signed by numerous health and education organizations.
Chairman Rokita. I thank the gentleman. Without objection,
so admitted.
And having no other business before the committee we are
adjourned for the day. Thank you very much.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
[Whereupon, at 12:47 p.m., the Subcommittees were
adjourned.]
[all]