    [House Hearing, 115 Congress]
    [From the U.S. Government Publishing Office]

            MEMBER DAY: TESTIMONY AND PROPOSALS ON THE OPIOID CRISIS

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

                                    HEARING

                                   BEFORE THE

                             SUBCOMMITTEE ON HEALTH

                                     OF THE

                        COMMITTEE ON ENERGY AND COMMERCE
                            HOUSE OF REPRESENTATIVES

                         ONE HUNDRED FIFTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                OCTOBER 11, 2017

                                   __________

                               Serial No. 115-64

          Printed for the use of the Committee on Energy and Commerce

                            energycommerce.house.gov
                                       ______

                         U.S. GOVERNMENT PUBLISHING OFFICE

    27-598 PDF                WASHINGTON : 2018

                        COMMITTEE ON ENERGY AND COMMERCE

                              GREG WALDEN, Oregon
                                     Chairman

    JOE BARTON, Texas                    FRANK PALLONE, Jr., New Jersey
      Vice Chairman                        Ranking Member
    FRED UPTON, Michigan                 BOBBY L. RUSH, Illinois
    JOHN SHIMKUS, Illinois               ANNA G. ESHOO, California
    TIM MURPHY, Pennsylvania             ELIOT L. ENGEL, New York
    MICHAEL C. BURGESS, Texas            GENE GREEN, Texas
    MARSHA BLACKBURN, Tennessee          DIANA DeGETTE, Colorado
    STEVE SCALISE, Louisiana             MICHAEL F. DOYLE, Pennsylvania
    ROBERT E. LATTA, Ohio                JANICE D. SCHAKOWSKY, Illinois
    CATHY McMORRIS RODGERS, Washington   G.K. BUTTERFIELD, North Carolina
    GREGG HARPER, Mississippi            DORIS O. MATSUI, California
    LEONARD LANCE, New Jersey            KATHY CASTOR, Florida
    BRETT GUTHRIE, Kentucky              JOHN P. SARBANES, Maryland
    PETE OLSON, Texas                    JERRY McNERNEY, California
    DAVID B. McKINLEY, West Virginia     PETER WELCH, Vermont
    ADAM KINZINGER, Illinois             BEN RAY LUJAN, New Mexico
    H. MORGAN GRIFFITH, Virginia         PAUL TONKO, New York
    GUS M. BILIRAKIS, Florida            YVETTE D. CLARKE, New York
    BILL JOHNSON, Ohio                   DAVID LOEBSACK, Iowa
    BILLY LONG, Missouri                 KURT SCHRADER, Oregon
    LARRY BUCSHON, Indiana               JOSEPH P. KENNEDY, III,
    BILL FLORES, Texas                   Massachusetts
    SUSAN W. BROOKS, Indiana             TONY CARDENAS, California
    MARKWAYNE MULLIN, Oklahoma           RAUL RUIZ, California
    RICHARD HUDSON, North Carolina       SCOTT H. PETERS, California
    CHRIS COLLINS, New York              DEBBIE DINGELL, Michigan
    KEVIN CRAMER, North Dakota
    TIM WALBERG, Michigan
    MIMI WALTERS, California
    RYAN A. COSTELLO, Pennsylvania
    EARL L. ``BUDDY'' CARTER, Georgia

                             Subcommittee on Health

                           MICHAEL C. BURGESS, Texas
                                     Chairman
    BRETT GUTHRIE, Kentucky              GENE GREEN, Texas
      Vice Chairman                        Ranking Member
    JOE BARTON, Texas                    ELIOT L. ENGEL, New York
    FRED UPTON, Michigan                 JANICE D. SCHAKOWSKY, Illinois
    JOHN SHIMKUS, Illinois               G.K. BUTTERFIELD, North Carolina
    TIM MURPHY, Pennsylvania             DORIS O. MATSUI, California
    MARSHA BLACKBURN, Tennessee          KATHY CASTOR, Florida
    CATHY McMORRIS RODGERS, Washington   JOHN P. SARBANES, Maryland
    LEONARD LANCE, New Jersey            BEN RAY LUJAN, New Mexico
    H. MORGAN GRIFFITH, Virginia         KURT SCHRADER, Oregon
    GUS M. BILIRAKIS, Florida            JOSEPH P. KENNEDY, III,
    BILLY LONG, Missouri                     Massachusetts
    LARRY BUCSHON, Indiana               TONY CARDENAS, California
    SUSAN W. BROOKS, Indiana             ANNA G. ESHOO, California
    MARKWAYNE MULLIN, Oklahoma           DIANA DeGETTE, Colorado
    RICHARD HUDSON, North Carolina       FRANK PALLONE, Jr., New Jersey (ex
    CHRIS COLLINS, New York                  officio)
    EARL L. ``BUDDY'' CARTER, Georgia
    GREG WALDEN, Oregon (ex officio)

                                      (ii)

                                 C O N T E N T S

                                  ----------
                                                                       Page
    Hon. Michael C. Burgess, a Representative in Congress from the
      State of Texas, opening statement..............................     1
    Hon. Gene Green, a Representative in Congress from the State of
      Texas, opening statement.......................................     3

                                   Witnesses

    Hon. Greg Walden, a Representative in Congress from the State of
      Oregon.........................................................     4
        Prepared statement...........................................     6
    Hon. Frank Pallone, Jr., a Representative in Congress from the
      State of New Jersey............................................     7
        Prepared statement...........................................     8
    Hon. Fred Upton, a Representative in Congress from the State of
      Michigan.......................................................     9
        Prepared statement...........................................    10
    Hon. Leonard Lance, a Representative in Congress from the State
      of New Jersey..................................................    11
        Prepared statement...........................................    12
    Hon. Doris O. Matsui, a Representative in Congress from the State
      of California..................................................    13
        Prepared statement...........................................    14
    Hon. Gus M. Bilirakis, a Representative in Congress from the
      State of Florida...............................................    15
        Prepared statement...........................................    16
    Hon. G.K. Butterfield, a Representative in Congress from the
      State of North Carolina........................................    17
        Prepared statement...........................................    18
    Hon. Larry Bucshon, a Representative in Congress from the State
      of Indiana.....................................................    19
        Prepared statement...........................................    20
    Hon. Robert E. Latta, a Representative in Congress from the State
      of Ohio........................................................    20
        Prepared statement...........................................    22
    Hon. Bill Johnson, a Representative in Congress from the State of
      Ohio...........................................................    23
        Prepared statement...........................................    24
    Hon. Peter Welch, a Representative in Congress from the State of
      Vermont........................................................    24
        Prepared statement...........................................    25
    Hon. Susan W. Brooks, a Representative in Congress from the State
      of Indiana.....................................................    26
        Prepared statement...........................................    27
    Hon. Ben Ray Lujan, a Representative in Congress from the State
      of New Mexico..................................................    28
        Prepared statement...........................................    30
    Hon. Nancy Pelosi, a Representative in Congress from the State of
      California.....................................................    31
        Prepared statement...........................................    32
    Hon. Markwayne Mullin, a Representative in Congress from the
      State of Oklahoma..............................................    33
        Prepared statement...........................................    34
    Hon. Paul Tonko, a Representative in Congress from the State of
      New York.......................................................    35
        Prepared statement...........................................    37
    Hon. Richard Hudson, a Representative in Congress from the State
      of North Carolina..............................................    38
        Prepared statement...........................................    39
    Hon. Joseph P. Kennedy, III, a Representative in Congress from
      the Commonwealth of Massachusetts..............................    40
    Hon. Bob Goodlatte, a Representative in Congress from the
      Commonwealth of Virginia.......................................    41
        Prepared statement...........................................    42
    Hon. Tim Walberg, a Representative in Congress from the State of
      Michigan.......................................................    43
        Prepared statement...........................................    44
    Hon. Harold Rogers, a Representative in Congress from the
      Commonwealth of Kentucky.......................................    45
        Prepared statement...........................................    46
    Hon. Earl L. ``Buddy'' Carter, a Representative in Congress from
      the State of Georgia...........................................    47
        Prepared statement...........................................    48
    Hon. Cheri Bustos, a Representative in Congress from the State of
      Illinois.......................................................    49
        Prepared statement...........................................    50
    Hon. Michael R. Turner, a Representative in Congress from the
      State of Ohio..................................................    51
        Prepared statement...........................................    52
    Hon. Roger W. Marshall, a Representative in Congress from the
      State of Kansas................................................    53
        Prepared statement...........................................    54
    Hon. Steve Stivers, a Representative in Congress from the State
      of Ohio........................................................    55
        Prepared statement...........................................    56
    Hon. Bradley Scott Schneider, a Representative in Congress from
      the State of Illinois..........................................    58
        Prepared statement...........................................    59
    Hon. Hakeem S. Jeffries, a Representative in Congress from the
      State of New York..............................................    60
        Prepared statement...........................................    61
    Hon. Evan H. Jenkins, a Representative in Congress from the State
      of West Virginia...............................................    62
        Prepared statement...........................................    63
    Hon. Brad R. Wenstrup, a Representative in Congress from the
      State of Ohio..................................................    64
        Prepared statement...........................................    65
    Hon. Katherine M. Clark, a Representative in Congress from the
      Commonwealth of Massachusetts..................................    66
        Prepared statement...........................................    67
    Hon. Elizabeth H. Esty, a Representative in Congress from the
      State of Connecticut...........................................    67
        Prepared statement...........................................    68
    Hon. Mia B. Love, a Representative in Congress from the State of
      Utah...........................................................    70
        Prepared statement...........................................    71
    Hon. Bill Pascrell, Jr., a Representative in Congress from the
      State of New Jersey............................................    71
        Prepared statement...........................................    72
    Hon. Thomas MacArthur, a Representative in Congress from the
      State of New Jersey............................................    73
        Prepared statement...........................................    74
    Hon. Tom O'Halleran, a Representative in Congress from the State
      of Arizona.....................................................    75
        Prepared statement...........................................    76
    Hon. Bruce Poliquin, a Representative in Congress from the State
      of Maine.......................................................    77
        Prepared statement...........................................    78
    Hon. David Rouzer, a Representative in Congress from the State of
      North Carolina.................................................    79
        Prepared statement...........................................    80
    Hon. David Young, a Representative in Congress from the State of
      Iowa...........................................................    81
        Prepared statement...........................................    82
    Hon. Earl Blumenauer, a Representative in Congress from the State
      of Oregon......................................................    83
        Prepared statement...........................................    84
    Hon. Karen C. Handel, a Representative in Congress from the State
      of Georgia.....................................................    84
        Prepared statement...........................................    85
    Hon. Charlie Crist, a Representative in Congress from the State
      of Florida.....................................................    86
        Prepared statement...........................................    87
    Hon. John J. Faso, a Representative in Congress from the State of
      New York.......................................................    88
        Prepared statement...........................................    89
    Hon. John Katko, a Representative in Congress from the State of
      New York.......................................................    90
        Prepared statement...........................................    91
    Hon. William R. Keating, a Representative in Congress from the
      Commonwealth of Massachusetts..................................    92
        Prepared statement...........................................    94
    Hon. Erik Paulsen, a Representative in Congress from the State of
      Minnesota......................................................    95
        Prepared statement...........................................    96
    Hon. Lisa Blunt Rochester, a Representative in Congress from the
      State of Delaware..............................................    97
        Prepared statement...........................................    98
    Hon. Judy Chu, a Representative in Congress from the State of
      California.....................................................    98
        Prepared statement...........................................    99
    Hon. Jackie Walorski, a Representative in Congress from the State
      of Indiana.....................................................   100
        Prepared statement...........................................   101
    Hon. Daniel M. Donovan, Jr., a Representative in Congress from
      the State of New York..........................................   102
        Prepared statement...........................................   102
    Hon. Vicky Hartzler, a Representative in Congress from the State
      of Missouri....................................................   103
        Prepared statement...........................................   104
    Hon. Brian K. Fitzpatrick, a Representative in Congress from the
      Commonwealth of Pennsylvania...................................   104
        Prepared statement...........................................   104
    Hon. Ryan A. Costello, a Representative in Congress from the
      Commonwealth of Pennsylvania...................................   106
        Prepared statement...........................................   107
    Hon. Keith J. Rothfus, a Representative in Congress from the
      Commonwealth of Pennsylvania...................................   108
        Prepared statement...........................................   109

                               Submitted Material

    Statement of Hon. Wm. Lacy Clay, a Representative in Congress
      from the State of Missouri, submitted by Mr. Burgess...........   110
    Statement of Hon. Anna G. Eshoo, a Representative in Congress
      from the State of California, submitted by Mr. Burgess.........   111
    Statement of Hon. Alcee L. Hastings, a Representative in Congress
      from the State of Florida, submitted by Mr. Burgess............   111
    Statement of Hon. David P. Joyce, a Representative in Congress
      from the State of Ohio, submitted by Mr. Burgess...............   112
    Statement of Hon. Ann M. Kuster, a Representative in Congress
      from the State of New Hampshire, submitted by Mr. Burgess......   114
    Statement of Hon. Stephen F. Lynch, a Representative in Congress
      from the Commonwealth of Massachusetts, submitted by Mr.
      Burgess........................................................   125
    Statement of Hon. David B. McKinley, a Representative in Congress
      from the State of West Virginia, submitted by Mr. Burgess......   126
    Statement of Hon. Richard M. Nolan, a Representative in Congress
      from the State of Minnesota, submitted by Mr. Burgess..........   131
    Statement of Hon. Niki Tsongas, a Representative in Congress from
      the Commonwealth of Massachusetts, submitted by Mr. Burgess....   131
    Article of August 17, 2017, ``Wilson sees 2 recent heroin, opioid
      overdose deaths,'' by Olivia Neeley, The Wilson Times,
      submitted by Mr. Butterfield...................................   133
    Article of August 23, 2017, ``As overdoses surge, agencies
      joining forces to help heroin, opioid addicts,'' by Olivia
      Neeley, The Wilson Times, submitted by Mr. Butterfield.........   134
    Article of May 30, 2015, ``A Choice for Recovering Addicts:
      Relapse or Homelessness,'' by Kim Barker, The New York Times,
      submitted by Mr. Green.........................................   136
    News release of the Department of Justice, U.S. Attorney's
      Office, Southern District of Florida, ``Owner Sentenced to More
      than 27 Years in Prison for Multi-Million Dollar Health Care
      Fraud and Money Laundering Scheme Involving Sober Homes and
      Alcohol and Drug Addiction Treatment Centers,'' May 17, 2017,
      submitted by Mr. Green.........................................   158

            MEMBER DAY: TESTIMONY AND PROPOSALS ON THE OPIOID CRISIS

                                  ----------

                          WEDNESDAY, OCTOBER 11, 2017

                       House of Representatives
                                Subcommittee on Health,
                              Committee on Energy and Commerce,
                                                        Washington, DC.
        The subcommittee met, pursuant to call, at 10:17 a.m., in
    room 2322, Rayburn House Office Building, Hon. Michael C.
    Burgess (chairman of the subcommittee) presiding.
        Members present: Representatives Burgess, Guthrie, Barton,
    Upton, Shimkus, Lance, Bilirakis, Bucshon, Brooks, Mullin,
    Hudson, Collins, Carter, Walden (ex officio), Green,
    Butterfield, Matsui, Lujan, Kennedy, Eshoo, and Pallone (ex
    officio).
        Staff present: Adam Buckalew, Professional Staff Member,
    Health; Kelly Collins, Staff Assistant; Zack Dareshori, Staff
    Assistant; Jordan Davis, Director of Policy and External
    Affairs; Paul Eddatel, Chief Counsel, Health; Adam Fromm,
    Director of Outreach and Coalitions; Caleb Graff, Professional
    Staff Member, Health; Jay Gulshen, Legislative Clerk, Health;
    Zach Hunter, Communications Director; Katie McKeogh, Press
    Assistant; Alex Miller, Video Production Aide and Press
    Assistant; Christopher Santini, Counsel, Oversight and
    Investigations; Kristen Shatynski, Professional Staff Member,
    Health; Jennifer Sherman, Press Secretary; Jeff Carroll,
    Minority Staff Director; Waverly Gordon, Minority Counsel,
    Health; Tiffany Guarascio, Minority Deputy Staff Director and
    Chief Health Advisor; Jourdan Lewis, Minority Staff Assistant;
    Jessica Martinez, Minority Outreach and Member Services
    Coordinator; Samantha Satchell, Minority Policy Analyst; Andrew
    Souvall, Minority Director of Communications, Member Services,
    and Outreach; Kimberlee Trzeciak, Minority Senior Health Policy
    Advisor; and C.J. Young, Minority Press Secretary.
        Mr. Burgess. Subcommittee will come to order, and I will
    recognize myself for an opening statement.

    OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A REPRESENTATIVE
                  IN CONGRESS FROM THE STATE OF TEXAS

        United States of America is in the midst of a fierce battle
    against an epidemic brought to us by opioids. It does not
    matter where you live. This crisis has touched every corner of
    American society.
        While New England and the Ohio Valley regions represent
    States hardest hit by the epidemic, health officials from the
    South and reaching across the West all report a growing number
    of overdose deaths in those counties.
        The latest figures from the Center for Disease Control and
    Prevention are astounding. Ninety-one Americans die every day
    from an overdose.
        Now, more than ever, we must come together and strengthen
    our commitment to fight this malady. I expect today's Members
    Day will bring to the forefront key insights and potential
    solutions on this critical issue.
        In the previous Congress, the Energy and Commerce Committee
    led several bipartisan initiatives to help address the opioid
    epidemic.
        The Comprehensive Addiction Recovery Act and the 21st
    Century Cures Act are now law and providing resources at the
    State and local levels.
        Much-needed policy changes are being implemented the
    passage of both CARA--with the passage of both CARA and Cures.
        In fact, as a result of CARA, patients suffering from
    substance abuse now have greater access to evidence-based
    treatment, addiction treatment services, and overdose reversal
    therapies.
        Cures, on the other hand, provided $1 billion in grants for
    States to support an array of prevention treatment and recovery
    services. I believe these initiatives are making a significant
    difference.
        At the same time, other issues have emerged in this fight.
    Earlier this year, our committee responded to reports of people
    overdosing on heroin laced with synthetic opioids--fentanyl,
    carfentanyl--which are 100 to 10,000 times more potent than
    morphine.
        The ready availability of these synthetic opioids have
    become a public health threat and illegal online pharmacies,
    primary operating in foreign countries, are exacerbating this
    epidemic every day for our State and Federal officials.
        Today's hearing will allow us to gain Member perspective on
    potential ways to complement existing policies and Federal
    regulations to combat the opioid epidemic.
        Representatives both on and off the Energy and Commerce
    Committee will testify about the opioid epidemic, share their
    stories, and propose legislative solutions for our
    consideration.
        In advance, I want to thank House Members for participating
    in this important discussion, and we look forward to hearing
    from everyone who's going to be before us today.
        Let me yield what little time I have left to the vice
    chairman of the Health Subcommittee, Mr. Guthrie.
        Mr. Guthrie. Thank you very much. Obviously, I am going to
    be brief.
        So many families have been devastated by this, and in
    ``Dreamland,'' which is a book that I read about the opioid
    crisis--an important book that I read about the opioid crisis--
    had all these different scenarios.
        But when you see it in reality, I was in Owensboro one
    evening and met a mom. The mom was the mother of an athletic
    student--an athlete and an honor student--who had her ACL torn
    playing soccer, was prescribed painkillers.
        After her recovery she was addicted to pain killers. Since
    she couldn't have access to them, turned to heroin, and passed
    away due to an overdose.
        This is a sad story that is repeated through all groups and
    all areas and it's something that I am looking forward to
    hearing all the testimony today to look for ideas to further do
    what Congress has done through CARA and moving forward as well.
        So I thank you, Mr. Chairman, for yielding and I yield back
    the balance of my time.
        Mr. Burgess. The Chair now recognizes the ranking member of
    the subcommittee, Mr. Green, 3 minutes for an opening
    statement, please.

       OPENING STATEMENT OF HON. GENE GREEN, A REPRESENTATIVE IN
                    CONGRESS FROM THE STATE OF TEXAS

        Mr. Green. Thank you, Mr. Chairman.
        The Centers for Disease Control and Prevention has called
    for prescription drug overdose abuse in the United States an
    epidemic, has found drug overdose to be the leading cause of
    injury death in the United States.
        Between 1999 and 2010, the death rate from prescription
    painkillers more than quadrupled and only continues to rise. In
    2015, more than 52,000 people died of drug overdoses in America
    and about two-thirds of those were linked to opioids.
        The toll is only rising. The New York Times' analysis of
    preliminary data found that 59,000 to 65,000 likely died from
    overdoses in 2016.
        Today, it's estimated that more than 2 million have use
    disorder and too few of these people are in treatment. The rate
    of heroin overdoses had increased dramatically in recent years.
        Its rise is directly linked to the opioid epidemic. In
    2010, approximately 3,000 drug-poisoning deaths were connected
    to heroin. In 2013, the number jumped to a total of 8,000
    overdose deaths and only continues to rise.
        There is no community that has not been touched by this
    crisis and some have been ravaged by it. This committee has
    taken steps to address the crisis but so much is needed to
    combat it when families and communities across the country are
    being torn apart.
        Included in the 21st Century Cares, or the State-targeted
    response to the opioid crisis grant program, it provided a
    billion dollars over 2017 to 2018 to States to address the
    opioid epidemic.
        Extending this money is a crucial part of any continued
    Federal efforts to respond to the epidemic. We need an approach
    that employs proven health--public health strategies and spans
    the entire spectrum from prevention to treatment and recovery.
        These include robust funding to support prevention, crisis
    response and expanded access to treatment and long--lifelong
    recovery tools.
        The Affordable Care Act is a vital part of our efforts to
    fight against the opioid epidemic. More than 1.5 million
    Americans with substance abuse use disorders have access to
    treatment through Medicaid that doesn't--that didn't before the
    ACA, thanks to the Medicaid expansion.
        Unfortunately, Americans fighting addiction that live in
    States that refuse to expand their Medicaid programs like Texas
    were left out in the cold.
        For those in the individual market, all plans must include
    services for substance abuse disorders and mental health, and
    consumers cannot be denied coverage because of a history of
    substance abuse, all thanks to the ACA.
        This is not a small feat. Prior to the ACA, roughly a third
    of all individual market policies didn't cover substance abuse
    treatment.
        Repealing the mental substance abuse disorder coverage
    provision of the ACA will remove at least $5.5 billion annually
    from the treatment of low-income people with mental and
    substance abuse disorders.
        Going even further is to gut the traditional Medicaid or
    scrap the Medicaid expansion in States that took the money
    would be absolutely devastating to our fight against
    prescription drug and heroin addiction crisis.
        We are in the midst of the largest public health crisis
    that our country has known and this is not time to cut health
    care safety nets that serve those in recovery.
        I am pleased that we have the opportunity to hear from our
    colleagues about their proposals and to combat the prescription
    drug epidemic.
        We need a comprehensive solution to the crisis that
    includes real dollars and targets the entire spectrum of
    addiction, prevention, crisis response for those who fall
    through the cracks, and expanding access to treatment and
    proving support for recovery.
        We must be guided by science and avoid stigmas and not fall
    into traps, misconceptions about proven treatment strategies.
        I thank the chairman for having this conversation and look
    forward to advancing new strategies and funding to turn the
    side of this growing crisis and really help families and
    communities that desperately need it.
        And I yield back my time.
        Mr. Burgess. Gentleman yields back. The Chair thanks the
    gentleman. I will just make an organizational note before we
    move to our first panel.
        We are going to be hearing from Energy and Commerce members
    at the outset. Energy and Commerce members are welcome to give
    their testimony from the witness table or from the dais,
    whichever they prefer.
        We are going to move to our first panel, which will consist
    of Chairman Walden, Ranking Member Pallone, Chairman Upton, Ms.
    Eshoo, and Chairman Latta, and again, you are welcome to
    testify either from the table or from the dais.
        So, with that, the Chair recognizes the chairman of the
    full committee, Mr. Walden.

      STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN CONGRESS
                        FROM THE STATE OF OREGON

        Mr. Walden. I thank the chairman.
        I come here today on behalf of my constituents like I do
    every day, but I think especially today, with our opportunity
    for all Members to make their case to the Energy and Commerce
    Committee, first we want to welcome them.
        And I think as our colleagues on both sides of the aisle
    have already said, all of us in all of our communities face
    these challenges related to drug overdoses.
        I held a round table the day before yesterday in Bend,
    Oregon, where I learned a lot about the problems they're facing
    and some of the successes they are having, and the importance
    of the work that we are doing here.
        It is a heartbreaking epidemic that has been featured on
    the front pages of our local newspapers, on national
    television, as part of the stories from our friends and family
    members, and with good reason.
        Conservative estimates forecast that more than 90 Americans
    die from opioid abuses overdoses each day--90 a day, Mr.
    Chairman, while more than a thousand are treated each day for
    abusing opioids.
        In 2016 alone, more than 64,000 Americans died from drug
    overdoses and in Oregon alone, more people died last year from
    drug overdoses than from car accidents.
        I recently held round tables in southern and central Oregon
    to discuss how we can better combat this crisis. Meeting with
    the people on the front lines of this fight in our communities
    to find out what is working, what more can be done, is crucial
    to our efforts to end this scourge.
        The Energy and Commerce Committee has led a number of
    bipartisan initiatives to help address the opioid epidemic,
    from groundbreaking initiatives that are now law like the
    Comprehensive Addiction and Recovery Act--CARA--and the 21st
    Century Cures Act.
        Resources are become available and important policy changes
    are being implemented to stem the tide of opioids.
        CARA established a comprehensive strategy for improving
    evidence-based treatment for patients with substance abuse
    disorders and it made significant changes to expand access to
    addiction treatment and services and overdose reversal
    medications.
        The new law also included criminal justice and law
    enforcement-related provisions. The 21st Century Cures Act
    provided a billion dollars in grants for States, the first half
    of which was made available in April of 2017 to be administered
    by the Substance Abuse and Mental Health Services
    Administration, or SAMHSA.
        My State of Oregon received $6.5 million in grants to help
    combat the epidemic that has plagued our great State. However,
    so much more work needs to be done.
        Since the passage of CARA and the 21st Century Cures Act,
    other issues have emerged in the fight against opioids such as
    the proliferation of fentanyl and its analogs, and then there
    are allegations of pill dumping and the practice of patient
    brokering.
        In my own district, I've heard the all-too-familiar tale of
    the mother whose oldest son was first prescribed opioids after
    injuring his ankle playing basketball. It didn't take long for
    him to become addicted.
        Another parent shared with me the story of his sister and
    nurse who died of an overdose after years of suffering from
    addiction and bounding between pharmacies, passing off forged
    prescriptions.
        He spoke about how better tracking and treatment could have
    helped catch his sister's problem earlier and perhaps made
    counseling more effective.
        As it was, she was the--she was only caught because two
    pharmacies in the small town happen to check with each other.
    You see, by then it was too late, though.
        These two stories may have come from Oregon, but they're
    not exclusive to the Beaver State. They're why we are here
    today.
        Addressing the opioid epidemic requires an all hands on
    deck effort. Today we'll be hearing testimony and stories from
    our colleagues both on and off the Energy and Commerce
    Committee about what more can be done and I am looking forward
    to hearing feedback and input from both sides of the aisle to
    hear about what is working and what is not and find ways to
    complement our existing law and to address emerging issues.
        So with that, Mr. Chairman, I appreciate everyone here
    today with us, taking time to participate. I look forward to
    hearing from all my colleagues, and together we must continue
    to fight this opioid crisis in America, and I yield back.
        [The prepared statement of Mr. Walden follows]:

                     Prepared statement of Hon. Greg Walden

        It's great to see so much activity in our hearing room
    today. While there are a lot of familiar faces, there are
    plenty that we don't see in here on a regular basis. For those
    folks, I'd like to say welcome to Energy and Commerce. I'm glad
    you could join us for this important opportunity to highlight
    the opioid crisis.
        The heartbreaking epidemic has been featured on the front
    pages of our local newspapers, on national television, and as
    part of stories from our friends and family members. And with
    good reason--conservative estimates forecast more than 90
    Americans die from opioid overdoses each day, while more than
    1,000 are treated each day for abusing opioids. In 2016 alone,
    more than 64,000 Americans died from drug overdoses, and in
    Oregon alone, more people died last year from drug overdoses
    than from car accidents.
        I recently held roundtables in southern and central Oregon
    to discuss how we can better combat the crisis. Meeting with
    the people on the front lines of this fight in our communities
    to find out what is working, and what more can be done, is
    crucial to our efforts to end this scourge.
        The Energy and Commerce Committee has led a number of
    bipartisan initiatives to help address the opioid epidemic.
    From groundbreaking initiatives that are now law, like the
    Comprehensive Addiction and Recovery Act (CARA) and the 21st
    Century Cures Act, resources are becoming available and
    important policy changes are being implemented to stem the tide
    of opioids.
        CARA established a comprehensive strategy for improving
    evidencebased treatment for patients with substance-use
    disorders and made significant changes to expand access to
    addiction treatment services and overdose reversal medications.
    The new law also included criminal justice and law enforcement-
    related provisions.
        The 21st Century Cures Act provided $1 billion in grants
    for States, the first half of which was made available in April
    2017, to be administered by the Substance Abuse and Mental
    Health Services Administration (SAMHSA). Oregon received $6.5
    million in grants to help combat the epidemic that has plagued
    our great State.
        However, more work needs to be done.
        Since the passage of CARA and the 21st Century Cures Act,
    other issues have emerged in the fight against opioids, such as
    the proliferation of fentanyl and its analogues, allegations of
    pill dumping, and the practice of patient brokering.
        In my own district, I've heard the all too familiar tale of
    the mother whose oldest son was first prescribed opioids after
    injuring his ankle playing basketball. It didn't take long for
    him to become addicted. Another parent shared with me the story
    of his sister, a nurse, who died of an overdose after years of
    suffering from addiction and bouncing between pharmacies
    passing off forged prescriptions. He spoke about how better
    tracking and treatment could have helped catch his sister's
    problem earlier and perhaps made counseling more effective. As
    it was, she was only caught because two pharmacies in a small
    town happened to check with each other. You see, by then it was
    too late.
        Those two stories may have come from Oregon, but they're
    not exclusive to my home State. And they're why we're here
    today.
        Addressing the opioid epidemic requires an all-hands-on-
    deck effort. Today we will be hearing testimony and stories
    from our colleagues both on and off the Energy and Commerce
    Committee about what more can be done. I'm looking forward to
    hearing feedback and input from both sides of the aisle--to
    hear about what's working and what's not, find ways to
    complement existing law, and to address emerging issues.
        I appreciate everyone here with us today taking the time to
    participate, and I look forward to hearing from my colleagues
    on both side of the aisle. Together, we must continue to fight
    to combat the opioid crisis.

        Mr. Burgess. Gentleman yields back. The Chair thanks the
    gentleman.
        And again, just to reiterate the format for today, members
    on the Energy and Commerce Committee are invited to either give
    testimony from the witness table or from the dais, whichever
    they prefer.
        So at this time I will recognize the ranking member of the
    full committee, Frank Pallone from New Jersey, for 5 minutes,
    please.

       STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN
                 CONGRESS FROM THE STATE OF NEW JERSEY

        Mr. Pallone. Thank you, Chairman Burgess.
        Today's Member Day provides us the opportunity to hear from
    our colleagues about how the epidemic is uniquely affecting
    their districts as well as to hear their ideas of additional
    efforts and funding that is needed to help individuals,
    families, and communities affected by this crisis.
        Like all communities across the country, the opioid
    epidemic is having devastating consequences in my home State.
    Drug overdoses are the leading causes of accidental death in
    New Jersey.
        According to the Centers for Disease Control and
    Prevention, there were--there was a 16 percent increase in drug
    overdose deaths in New Jersey between 2014 and 2015, and last
    year drug overdose deaths topped more than 2,000.
        And unfortunately, we are continuing to see increased
    deaths from this tragic epidemic. I am proud of the steps this
    committee has taken to respond to this tragic epidemic that is
    taking the lives of 91 Americans every day.
        I am pleased that we worked together in a bipartisan
    fashion to pass the Comprehensive Addiction and Recovery Act,
    or CARA. We also worked together to create the State-targeted
    response to the opioid crisis grant program as part of the 21st
    Century Cures Act and this grant program provides a billion to
    States to address the opioid epidemic.
        There were positive and--well, these were positive and
    bipartisan laws that we produced in 2016 during the last year
    of the Obama administration. That was 2016. Two thousand
    seventeen has been much different.
        Congressional Republicans have spent much of this year
    trying to repeal the Affordable Care Act, which would have
    prevented millions of Americans from getting the help that they
    need to treat opioid use disorders and the repeal legislation
    passed here in the House would have allowed insurers to once
    again discriminate against people with preexisting conditions
    such as opioid use disorders.
        The Republican-passed bill would also have allowed States
    to waive essential health benefits including mental health and
    substance use treatment.
        But, thankfully, those repeal efforts have failed to date.
    So as we move forward, what is clear is that individuals with
    substance use disorder, their families, and their communities
    need us to work together to do more.
        Despite some progress here in Washington, the epidemic has
    shown no signs of relenting and that is why we must continue to
    support and increase funding for proven health--public health
    approaches spanning the entire spectrum from crisis to
    recovery, including expanding access to medication-assisted
    treatment.
        Those efforts should include more funding and we should
    extend the State-targeting response to the opioid crisis grant
    program so that we can expand even further people's access to
    opioid abuse treatment, prevention, and recovery support
    services.
        So I look forward to hearing from my House colleagues and
    continuing to work together in a bipartisan fashion to help our
    country respond to this crisis.
        I yield back, Mr. Chairman.
        [The prepared statement of Mr. Pallone follows:]

                 Prepared statement of Hon. Frank Pallone, Jr.

        Thank you Chairman Burgess. Today's Member Day provides us
    the opportunity to hear from our colleagues about how the
    epidemic is uniquely affecting their districts as well as to
    hear their ideas of additional efforts and funding that is
    needed to help individuals, families, and communities affected
    by this crisis.
        Like all communities across the country, the opioid
    epidemic is having devastating consequences in my home State.
    Drug overdoses are the leading cause of accidental death in New
    Jersey. According to the Centers for Disease Control and
    Prevention, there was a 16 percent increase in drug overdose
    deaths in New Jersey between 2014 and 2015. Last year, drug
    overdose deaths topped more than 2,000. And unfortunately, we
    are continuing to see increased deaths from this tragic
    epidemic.
        I am proud of steps this committee has taken to respond to
    this tragic epidemic that is taking the lives of 91 Americans
    every day. I am pleased that we worked together in a bipartisan
    fashion to pass the Comprehensive Addiction and Recovery Act
    (CARA). We also worked together to create the State Targeted
    Response to the Opioid Crisis grant program as part of the 21st
    Century CURES Act. This grant program provides $1 billion to
    States to address the opioid epidemic.
        These were positive and bipartisan laws that we produced in
    2016 during the last year of the Obama administration. That was
    2016--2017 has been much different. Congressional Republicans
    have spent much of this year trying to repeal the Affordable
    Care Act, which would have prevented millions of Americans from
    getting the help that they need to treat opioid use disorders.
        The repeal legislation passed here in the House would have
    allowed insurers to once again discriminate against people with
    preexisting conditions, such as opioid use disorders. The
    Republican passed bill would also have allowed States to waive
    essential health benefits, including mental health and
    substance use treatment. Thankfully, repeal efforts have failed
    to date.
        As we move forward, what's clear is that individuals with
    substance use disorder, their families, and their communities
    need us to work together to do more. Despite some progress here
    in Washington, the epidemic has shown no signs of relenting.
    That is why we must continue to support and increase funding
    for proven public health approaches spanning the entire
    spectrum from crisis to recovery, including expanding access to
    medication-assisted treatment. Those efforts should include
    more funding. We should extend the State Targeting Response to
    the Opioid Crisis grant program so that we expand even further
    people's access to opioid abuse treatment, prevention, and
    recovery support services.
        I look forward to hearing from my House colleagues and
    continuing to work together in a bipartisan fashion to help our
        I yield back.

        Mr. Burgess. Gentleman yields back. The Chair thanks the
    gentleman.
        Chair recognizes the chairman of the Energy Subcommittee,
    Mr. Upton, for 3 minutes.

    STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM
                         THE STATE OF MICHIGAN

        Mr. Upton. Well, thank you, Mr. Chairman.
        This is very important, this Member Day, as we are able to
    all share our personal experiences on a crisis that has been
    plaguing our Nation over the last couple of years--opioid
    addiction and abuse.
        This silent epidemic has for sure torn through families,
    neighbourhoods, and communities, both certainly in my home
    State of Michigan. But we know across the country as well.
        In fact, in 2015, there were nearly 2,000 opioid abuse-
    related deaths in Michigan alone. Even more tragically, more
    than 22,000 babies are born every year across the country with
    neonatal opioid withdrawal syndrome.
        This terrible epidemic has hit home both in my community
    and, yes, even in my extended family. So this is very personal
    to me as it is with so many throughout our communities.
        In the last couple of years, I have been meeting with first
    responders, crisis center employees, advocacy groups, and yes,
    individuals suffering.
        All of these folks have said that, tragically, the death
    toll continues to rise. That is why we have been taking
    concrete steps here in this committee to combat the widespread
    epidemic.
        Just last year, the President signed into his sweeping
    package aimed at attacking the opioid epidemic from all sides.
        As part of 21st Century Cures, a bill that every one of our
    committee members supported, an additional $1 billion was
    allocated to the States like Michigan to address opioid
    addiction, treatment and prevention.
        This year the first round of funding was delivered. We
    received $16 million and that grant funding will make a real
    difference. It will.
        To those suffering I just say help is on the way, and as a
    result of this legislation as well as administrative action,
    NIH Director Francis Collins is helping to lead the charge.
        This summer, the NIH started meeting with experts in
    academia and the biopharmaceutical industry to talk about
    innovative ways in which Government and industry can work
    together to address the crisis.
        I strongly support that work and look forward to seeing the
    results of the research that NIH is doing with its industry
    partners.
        There are also things that we in Congress can help NIH with
    in these endeavors. First, we need the NIH to develop more
    options for overdose reversals.
        Second, we need the evidence that the NIH can develop an
    effective therapy for addiction, and finally, we must
    accelerate the development of nonaddictive pain medicines.
        The sooner that we in Congress supply the resources
    necessary to conduct that work, the sooner that we can supply
    powerful new tools for every community.
        These efforts can't happen fast enough and these are some
    of the many reasons that I continue to support robust NIH
    funding.
        There is more work to be done, and here in Congress we will
    continue to take steps to address that epidemic and in this
    committee we are on the front lines to advance meaningful
    bipartisan legislation that indeed will make a difference.
    Together, we will bring it out of the shadows.
        I yield back.
        [The prepared statement of Mr. Upton follows:]

                     Prepared statement of Hon. Fred Upton

        Mr. Chairman, thank you for holding this very important
    Member Day hearing on a crisis that has been plaguing our
    Nation over the last several years--opioid addiction and abuse,
    This silent epidemic has torn through families, neighborhoods,
    and communities both in my home State of Michigan and indeed
    across the entire country. In fact, in 2015, there were nearly
    2,000 opioid abuse related deaths in Michigan alone.
        In the last few years I have been meeting with first
    responders, crisis center employees, advocacy groups, and yes--
    individuals suffering. All of these folks have said that,
    tragically, the death toll continues to rise.
        This is why we have been taking concrete action here in the
    Energy and Commerce Committee to combat this widespread
    epidemic. Just last year, the president signed into law a
    sweeping package aimed at attacking the opioid epidemic from
    all sides.
        As part of my landmark, bipartisan 21st Century Cures Act,
    an additional $1 billion was allocated to States, like
    Michigan, to address opioid addiction treatment and prevention.
    Just this year, the first round of that funding was delivered.
        Michigan received more than $16 million. This grant funding
    will make a real difference. To those suffering, I just say
    this: Help is on the way.
        As a result of my legislation as well as administrative
    action, my good friend Dr. Francis Collins is helping to lead
    the charge in his position as director of the National
    Institutes of Health. This summer, the NIH started meeting with
    experts in academia and the biopharmaceutical industry to talk
    about innovative ways in which Government and industry can work
    together to address this crisis. I strongly support this work
    and look forward to seeing the results of the research NIH is
    doing with its industry partners.
        There are also things we in Congress can help NIH with in
    these endeavors. First, we need NIH to develop more options for
    overdose reversal. Second, we need the evidence NIH can develop
    on effective therapies for addiction. And finally, we must
    accelerate the development of nonaddictive pain medicines. The
    sooner we in Congress supply the resources necessary to conduct
    this work, the sooner we can supply powerful new tools for our
    communities. These efforts can't happen fast enough, and these
    are some of the many reasons that I continue to support robust
    NIH funding.
        There is more work to be done. Clearly. And here in
    Congress we will continue to take steps to address this
    epidemic. Here in this committee, we're on the front lines in
    advancing meaningful, bipartisan legislation that will make a
    difference. Together, we can take this ``silent epidemic'' and
    bring it out of the shadows.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        Chair recognizes the gentleman from New Jersey, Mr. Lance,
    3 minutes, please.

     STATEMENT OF HON. LEONARD LANCE, A REPRESENTATIVE IN CONGRESS
                      FROM THE STATE OF NEW JERSEY

        Mr. Lance. Thank you, Mr. Chairman, and I must say this is
    the first time I've been on this side of the dais and what a
    fine looking group.
        Mr. Green. It is more fun being over here, as you know.
        Mr. Burgess. If it makes the gentleman more comfortable, we
    can swear you in.
        [Laughter.]
        Mr. Lance. That means I would be under oath.
        Mr. Burgess. Yes.
        Mr. Lance. Thank you, Chairman Burgess, for organizing this
    conversation today. The opiate crisis is devastating families
    and communities across New Jersey, the State I represent.
        In 2015, the Garden State's death rate was two and a half
    times the skyrocketing U.S. rate. We are making progress with
    the implementation of the Comprehensive Addiction Recovery Act
    of 2016, but more work needs to be done.
        I acknowledge the efforts of one of my constituents,
    Basking Ridge resident Clodette Sabatelle. Clodette has done
    critical work and has made a positive difference in the lives
    of those suffering from drug addiction.
        Her advocacy group, Community in Crisis, helps equip the
    loved ones of those in pain. None of the progress we have made
    so far in this fight against drug addiction and opiate abuse
    would have been possible without the work of people like
    Clodette and organizations like Community in Crisis. Their
    efforts are efforts that we should make sure Congress
    understands and applauds.
        I worked closely with Clodette on the issue of over
    prescription. In 2012, health care providers wrote 259 million
    prescriptions for opiates.
        The CARA provisions I authored addressed that issue by
    reforming and improving the medical drug approval and label
    process at the Food and Drug Administration.
        For the first time, Congress has required the agency to
    work closely with expert advisory committees before making
    critical product approval and labeling decisions and to make
    recommendations regarding educational programs for prescribers
    of extended release and long-acting opiates.
        CARA also encourages the development and approval of
    opiates with abuse-deterrent properties. We also have to make
    sure resources such as the State-targeted response to the
    opiate crisis grants administered by the Substance Abuse and
    Mental Health Services Administration continue to give States
    the tools they need to experiment and test best practices.
        New Jersey recently secured a $13 million Federal grant
    from the Substance Abuse and Mental Health Services
    Administration to focus on this crisis.
        The Drug-Free Community Support program in the White House
    Office of National Drug Control Policy also recently awarded
    Community in Crisis and two other able organizations Hunterdon
    Prevention Resource and EmPoWER Somerset, each with a $125,000
    grant to assist addressing the problem of opiate and heroin
    abuse, provide education, and implement prevention measures.
        Community in Crisis Hunterdon Prevention Resource and
    EmPoWER Somerset are great partners in connecting people with
    the resources and support they need.
        These investments are not only the right thing to do but
    help lessen the significant strain on law enforcement
    resources. I commend each group on its important work.
        Mr. Chairman, I stand ready to work with you and colleagues
    on both sides of the aisle to continue this work. Thank you for
    calling this hearing today.
        [The prepared statement of Mr. Lance follows:]

                    Prepared statement of Hon. Leonard Lance

        Thank you, Chairman Burgess, for organizing this
    conversation today.
        The Energy and Commerce Committee has done a lot right in
    the fight against drug addiction. Last year's landmark
    legislation set up lanes for success but it is going to be up
    to this committee to make sure the administration, the
    respective agencies and all stakeholders continue this effort
    to implement the Comprehensive Addiction and Recovery Act of
    2016 and do all we can for those in need. I think today's
    Member Day demonstrates we are committed to doing that.
        The opioid crisis is devastating families and communities
    across the Garden State. In 2015, New Jersey's heroin death
    rate was two-and-one-half times the skyrocketing U.S. rate. We
    are making progress with CARA's implementation but there is
    much more work to be done. Too often we are hearing about
    another life cut short from the scourge of drug addiction. This
    is not just a New Jersey problem, but an epidemic facing the
    entire country. We need to be working together and empowering
    the groups and organizations that are succeeding in turning the
    tide against drug abuse.
        I would like to acknowledge the efforts of one of my
    constituents, Basking Ridge resident Clodette Sabatelle.
    Clodette has done critical work and has made a difference in
    the lives of those suffering from drug addiction. Her advocacy
    group, Community in Crisis, helps empower and equip the loved
    ones of those in pain. None of the progress we have made so far
    in this fight against drug addiction and opioid abuse would
    have been possible without the work of people like Clodette and
    organizations like Community in Crisis. Their efforts equipped
    Congress to act and helped craft and champion the CARA
    legislation.
        I worked closely with Clodette on the issue of over
    prescription. In 2012, health care providers wrote 259 million
    prescriptions to people for opioids. The CARA provisions I
    authored address that issue by reforming and improving the
    medical drug approval and label process within the Federal Food
    and Drug Administration. For the first time, Congress has
    required the agency to work closely with expert advisory
    committees before making critical product approval and labeling
    decisions and to make recommendations regarding education
    programs for prescribers of extended-release and long-acting
    opioids. CARA also encourages the development and approval of
    opioids with abuse-deterrent properties.
        We also have to make sure resources such as the State
    Targeted Response to the Opioid Crisis Grants administered by
    the Substance Abuse and Mental Health Services Administration
    continue to give States the tools they need to experiment and
    test best practices. New Jersey recently secured a $13 million
    Federal grant from the Substance Abuse and Mental Health
    Services Administration to prioritize five specific strategies:
    strengthening public health surveillance, advancing the
    practice of pain management, improving access to treatment and
    recovery services, targeting availability and distribution of
    overdose-reversing drugs and supporting cutting-edge research.
        The Drug-Free Communities Support Program the White House
    Office of National Drug Control Policy also recently awarded
    Community in Crisis and two other very able organizations,
    Hunterdon Prevention Resource and Empower Somerset, each with a
    $125,000 grant to assist addressing the problem of opioid and
    heroin abuse, provide education and implement prevention
    measures. Community in Crisis, Hunterdon Prevention Resource
    and Empower Somerset are great partners in connecting people
    with the resources and support they need. These investments are
    not only the right thing to do, but help lessen the significant
    strain on law enforcement resources. I commend each group on
    its important work.
        Mr. Chairman, I stand ready to work with you and colleagues
    on both sides of the aisle to continue this work. Thank you for
    calling this hearing today.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back. And the Chair wants to thank this panel.
        We will move to our second panel. Members identified
    wishing to speak in the second panel: Mr. Butterfield of North
    Carolina, Ms. Matsui in California, and Mr. Bilirakis of
    Florida.
        Again, Members are advised they may either speak from the
    witness table or from the dais, whichever is their preference.
        So the Chair recognizes Ms. Matsui of California for 3
    minutes.

    STATEMENT OF HON. DORIS O. MATSUI, A REPRESENTATIVE IN CONGRESS
                      FROM THE STATE OF CALIFORNIA

        Ms. Matsui. Thank you, Mr. Chairman, for inviting us today
    to testify about proposals to address our Nation's opioid
    epidemic.
        We all have heartbreaking stories of constituents whose
    lives were lost too soon to an opioid overdose. In my home
    district of Sacramento, they have experienced a particularly
    deadly overdose crisis last year due to pills contaminated with
    fentanyl, which is as much as 50 times stronger than heroin.
        Addiction is a devastating disease that knows no bounds and
    we must come together to provide solutions in a comprehensive
    manner. In this committee, we took a step forward by passing
    the Comprehensive Addition and Recovery Act into law last year.
        We need to build on these efforts. Understanding addiction
    and its consequences are multipronged and we need a
    multipronged solution.
        I look at this problem as I do any other health care
    problem, which means I examine it holistically across the
    spectrum from prevention to early intervention to treatment.
        In the case of the opioid epidemic there is a lot we can do
    at each of these stages, all of which rest on truly building up
    our Nation's mental health system and integrating behavior
    health care with physical health care.
        Historically, mental health and addiction have bee treated
    as character flaws and therefore not addressed with evidence-
    based medical treatment. We can reverse that course by making
    treatment more available, bolstering our mental health work
    force, and reducing stigma.
        In 2012, Representative Lance and Senators Stabenow, Blunt,
    and I passed the Excellence in Mental Health Demonstration
    Project into law. This project is allowing States to
    demonstrate that building up Community-Based Behavioral Health
    Clinics improves access to care.
        Last week, we introduced legislation to extend the years of
    the program and expand it to more States. We should strongly
    consider this as one way to help address the opioid crisis.
        We also need to enforce mental health parity laws to make
    sure health insurers are offering mental health benefits equal
    to physical health benefits.
        However, this work on parity is irrelevant if mental health
    benefits are not offered in the first place. There have been
    proposals which included provisions that allow States to waive
    essential health benefits, meaning insurance once again not be
    required to cover mental health and addiction treatments.
    That's not good.
        Cutting billions from the Medicaid program would also mean
    loss of coverage from millions suffering from substance use
    disorder. We cannot take these steps backward.
        I am encouraged by steps being taken across the health care
    sector to address the crisis including the limiting of opioid
    prescriptions for prescribes and insurers.
        We need to build on these efforts. That includes
    considering proposals in Congress to provide resources and
    training for State and local enforcement and bolstering a
    mental health workforce, educating the public, addressing
    availability of a range of treatment options from outpatient to
    inpatient to residential care and more.
        And I do look forward to continuing to work with the
    committee on these policy proposals to address this pressing
    issue.
        Thank you, and I yield back.
        [The prepared statement of Ms. Matsui follows:]

                   Prepared statement of Hon. Doris O. Matsui

        Thank you, Mr. Chairman, for inviting us to testify today
    about proposals to address our Nation's opioid epidemic. We all
    have heartbreaking stories of constituents whose lives were
    lost too soon to an opioid overdose. In my home district of
    Sacramento, we experienced a particularly deadly overdose
    crisis last year due to the introduction of pills contaminated
    with fentanyl, which is as much as 50 times stronger than
    heroin.
        Addiction is a devastating disease that knows no bounds and
    impacts us all, and we must come together to provide solutions
    in a comprehensive manner.
        In this committee, we took a first step by passing the
    Comprehensive Addiction and Recovery Act, or CARA, into law
    last year. We need to build on those efforts; understanding
    addiction and its consequences are multipronged, we need a
    multipronged solution.
        I look at this problem as I do any other health care
    problem or disease, which means I examine it holistically
    across the spectrum from prevention to early intervention to
    treatment.
        In the case of the opioid epidemic, there is a lot we can
    do at each of these stages, all of which rest on truly building
    up our Nation's mental health system and integrating behavioral
    health care with physical health care.
        If people are able to get behavioral health treatment when
    they need it in their communities, we can start to address the
    root causes of addiction and prevent and catch issues earlier.
    Historically, mental health and addiction have been treated as
    character flaws and therefore not addressed with evidence-based
    medical treatment. We can reverse that course by making
    treatment more available, bolstering our mental health
    workforce, and reducing stigma.
        In 2012, Rep. Lance and Senators Stabenow, Blunt, and I
    passed the Excellence in Mental Health Demonstration project
    into law. This project is allowing States and local communities
    to demonstrate that building up Community-Based Behavioral
    Health Clinics, in coordination with physical health clinics
    and community resources, will improve access to care. This
    project is currently in eight States, and last week we
    introduced the Excellence in Mental Health and Addiction
    Treatment Expansion Act to extend the years of the demo and
    expand it to more States. We should strongly consider this
    project and legislation as a way to build up community care to
    address the opioid crisis.
        We also need to ensure that mental health parity is truly
    achieved. When an insurance company offers mental health
    benefits, they should be equal to physical health benefits
    offered. We need to ensure that this rule is being followed
    across the country. However, the rule is irrelevant if mental
    health benefits are not offered in the first place. Trumpcare
    proposals have included provisions that allow States to waive
    essential health benefits, meaning insurers would once again
    not be required to cover mental health and addiction treatment.
    Cutting billions of dollars from the Medicaid program would
    also mean loss of coverage for millions of Americans suffering
    from substance use disorder. We cannot take these steps
    backward.
        I am encouraged by steps that are being taken across the
    health care sector to address the crisis. Prescribers and
    insurers are limiting opioid prescriptions , such as for pain
    following a surgery, to seven days. This prevents bottles of
    extra unused pills from sitting in people's medicine cabinets,
    as do prescription drug ``take back'' days where people can
    turn in unused pills to the DEA.
        We need to build on these efforts and work together across
    the system. That includes considering proposals in Congress
    that provide resources and training for State and local law
    enforcement, bolstering our mental health workforce, educating
    the public on what they can do to prevent or react to a crisis,
    addressing the availability of a range of treatment options
    from outpatient to inpatient to residential care, and more. I
    look forward to continuing to work with the committee on policy
    proposals to address this pressing issue.

        Mr. Burgess. Chair thanks the gentlelady. Gentlelady yields
    back.
        Chair recognizes the gentleman from Florida, Mr. Bilirakis,
    for 3 minutes, please.

        STATEMENT OF HON. GUS M. BILIRAKIS, A REPRESENTATIVE IN
                   CONGRESS FROM THE STATE OF FLORIDA

        Mr. Bilirakis. Thank you, Mr. Chairman.
        The United States is in the midst of an opioid overdose
    epidemic. Sadly, 91 Americans die every day due to opioid
    overdoses. Nearly half of all opioid overdose deaths involve a
    prescription opioid.
        In 2010, in response to the opioid crisis in Florida's pill
    mill problem, Florida's legislature enacted statewide tracking
    of painkiller prescriptions coupled with law enforcement using
    drug trafficking laws to prosecute providers caught over
    prescribing. Within 3 years, Florida saw a decrease of more
    than 20 percent in overdose deaths.
        Despite this positive trend, opioid abuse continues to
    plague my district. In fact, my district had the second-highest
    prescription drug death rate in Florida in 2014.
        In response, I worked last Congress to ensure that Pasco
    County was included as a high-intensity drug trafficking area,
    enabling law enforcement to receive additional resources to
    combat the spread of drug-related crime.
        I want to applaud the committee for including my bills, the
    Medicare Patient Safety and Drug Abuse Prevention Act and the
    Promise Act in CARA, which passed last Congress.
        The Medicare Patient Safety and Drug Abuse Prevention Act
    created a pharmacy and physician block-in program within the
    Medicare Advantage and Medicare Part D, giving CMS the tools to
    crack down on this abuse in the Medicare program and it's
    important for us to maintain oversight, of course, as you know,
    on this program as CMS is developing the rules.
        The Promise Act will increase safety for opioid therapy and
    pain management by requiring the VA and DoD to update their
    clinical practice guidelines for managing of opioid therapy for
    chronic pain, requiring the VA opioid prescribes to have the
    enhanced pain management and safe opioid prescribing education
    and training and encourage the VA to increase information
    sharing with State licensing boards. I think that is critical.
        As part of the 21st Century Cures Act, Florida has received
    over $27 million in grants to help fight the opioid epidemic by
    increasing access to treatment and recovery services,
    strengthening public health surveillance, and improving pain
    management practices.
        These critical funds are supporting Florida's all-hands-on-
    deck approach across the State to curb opioid abuse and save
    lives.
        I am pleased the administration and this committee are
    leading the charge on this critical issue and I look forward to
    working together to help save lives and prevent addiction.
        I yield back, Mr. Chairman. Thank you.
        [The prepared statement of Mr. Bilirakis follows:]

                  Prepared statement of Hon. Gus M. Bilirakis

        Thank you Mr. Chairman for hosting today's Member Day to
    discuss the impact of opioid abuse in our communities.
        The United States is in the midst of an opioid overdose
    epidemic. According to the Centers for Disease Control and
    Prevention, more citizens died from drug overdoses in 2015 than
    any other year on record. Of those deaths, six out of ten
    involve opioids. Last year, an estimated 60,000 Americans died
    due to drug overdoses, more than all the Americans who died in
    the Vietnam War. Sadly, 91 Americans die every day due to
    opioid overdoses. Nearly half of all opioid overdose deaths
    involve a prescription opioid.
        Florida has been in the crosshairs of this epidemic. In
    2010, in response to the opioid crisis and Florida's `pill
    mill' problem, Florida's legislature enacted statewide tracking
    of painkiller prescriptions coupled with law enforcement using
    drug trafficking laws to prosecute providers caught
    overprescribing. Within 3 years, Florida saw a decrease of more
    than 20 percent in overdose deaths.
        Despite this positive trend, opioid abuse continues to
    plague my district--Florida's 12th District. Pasco and Pinellas
    counties had some of the highest oxycodone-caused deaths-almost
    200 in 2014. In fact, my district had the second-highest
    prescription drug death rate in Florida in 2014. In response, I
    worked last Congress to ensure that Pasco County was included
    as a High Intensity Drug Trafficking Area (HIDTA), which has
    enabled law enforcement to receive additional resources to
    combat the spread of drug-related crime.
        Additionally, I invited the head of the Office of National
    Drug Control Policy to visit my district last year. We toured
    local facilities and met with law enforcement, key health care
    providers, patients, and experts to determine the next steps in
    addressing this problem. I want to applaud the committee for
    including my bills, the Medicare Patient Safety and Drug Abuse
    Prevention Act and PROMISE Act in the Comprehensive Addiction
    and Recovery Act which passed last Congress. The Medicare
    Patient Safety and Drug Abuse Prevention Act created a pharmacy
    and physician lock-in program within Medicare Advantage and
    Medicare Part D. Private insurance was already using this
    strategy against doctor and pharmacy shopping, and States had
    adopted it as part of the Medicaid program. This gives CMS the
    tools to crackdown on this abuse in the Medicare program, and
    it's important for us to maintain oversight on this program as
    CMS is developing the rules. Furthermore, the PROMISE Act will
    increase safety for opioid therapy and pain management by
    requiring the VA and DOD to update their Clinical Practice
    Guidelines for Management of Opioid Therapy for Chronic Pain,
    requiring VA opioid prescribers to have enhanced pain
    management and safe opioid prescribing education and training,
    and encourages the VA to increase information sharing with
    State licensing boards.
        As part of the 21st Century Cures Act this Congress,
    Florida has received over $27 million in grants to help fight
    the opioid epidemic by increasing access to treatment and
    recovery services, strengthening public health surveillance,
    and improving pain management practices. These critical funds
    are supporting Florida's all-hands-on-deck approach across the
    State to curb opioid abuse and save lives.
        Now the rise in fentanyl and its various derivatives have
    presented new challenges to my State. However, we remain
    optimistic with Florida's recent legislative initiatives
    including:
         Requiring doctors to log prescriptions in a
    statewide painkiller database by the end of the next business
    day to curb `doctor shopping';
         And setting aside State funds for medications that
    can help reduce opioid dependency, most of which will be spent
    in the State prison system.
        We need to continue to work closely with local law
    enforcement, medical professionals, addiction treatment
    specialists, and those impacted by addiction. I am pleased the
    administration and this committee are leading the charge on
    this critical issue, and I look forward to working together to
    help save lives and prevent addiction. Thank you and I yield
    back the remaining balance of my time, Mr. Chairman.

        Mr. Burgess. Gentleman yields back. The Chair thanks the
    gentleman.
        Chair recognizes the gentleman from North Carolina, Mr.
    Butterfield, for 3 minutes, please.

        STATEMENT OF HON. G.K. BUTTERFIELD, A REPRESENTATIVE IN
               CONGRESS FROM THE STATE OF NORTH CAROLINA

        Mr. Butterfield. Thank you very much, Mr. Burgess, and to
    my fellow colleagues. Thank you for opportunity to address the
    committee today about the state of the opioid epidemic in my
    home State of North Carolina.
        And let me just begin, Mr. Chairman, by crediting my friend
    and our former colleague, Mary Bono, who was also up from
    Florida--Mr. Bilirakis, who talked so incessantly about this
    issue because it was very dear to her and she knew the impact
    that it was having on her State.
        Ms. Mack brought this important topic to the forefront of
    our subcommittee some years ago. She was the chairman of the
    subcommittee, and I was the ranking member.
        At first, Mr. Chairman, I thought Mary was a little bit
    overreacting to the opioid crisis in Florida because it had
    touched her family personally.
        But after we had hearings and after I looked into it, I
    came to the conclusion that she was not overreacting--that it
    was indeed an epidemic not just in Florida but all across the
    country.
        Just last year, I worked with many of my colleagues in this
    room on the Comprehensive Addiction and Recovery Act that was
    passed into law. That bill included, roughly, 20 different
    legislative proposals to help slow the epidemic. As part of the
    21st Century Cures Act, this committee approved $500 million.
        The American people need to know that, Mr. Chairman. We
    approved $500 million in supplemental funding to address opioid
    abuse.
        Despite the investments and attention from Congress, we are
    still feeling the opioid crisis very close to home. During the
    August work period I saw the effects of the epidemic on my
    small community in Wilson, North Carolina. Just in August
    alone, there were two deaths because of the opioid abuse in the
    community.
        According to reports in the Wilson Times--and I have a copy
    of that with me today--medics in Wilson County administered the
    appropriate drug in response to opioid crisis 28 times by mid-
    August, when they usually administered the treatment 30 times
    per quarter.
        According to Chris Parker with the Wilson County Emergency
    Medical Services, there is a definite increase in opioid use
    and abuse in our county.
        North Carolina has a real problem on its hands. America has
    a real problem on its hands. By July of this year, there were
    more than 500 diagnoses for emergency department visits, up
    from 410 at the same point last year.
        Regrettably, Mr. Chairman, in my humble opinion, the
    administration is not taking this situation seriously. The
    budget offered by the current administration cuts HHS funding
    by 16 percent, the CDC by 17 percent, the National Institutes
    of Health by 19 percent.
        I am also very concerned about the proposals to get the
    Medicaid program that we have considered in this committee. The
    Center for Budget and Policy Priorities estimates that nearly
    100,000 people with an opioid use disorder have gained coverage
    through Medicaid expansion under ACA.
        Congress must do all that it can to help stop this epidemic
    from devastating more lives, more families, and communities.
        Congress should provide certainty--certainty and funding to
    combat this epidemic, which is why I am the original cosponsor
    of H.R. 3495, the Opiate and Heroin Abuse Crisis Investment Act
    of 2017 that was introduced by Mr. Lujan.
        We must also protect existing fundings for research in
    opioid use disorder coverage, provide tools to communities to
    address this epidemic, and reduce the stigma for those needing
    treatment.
        So I want to thank you for convening this hearing. I want
    to thank Mr. Latta, Mr. Bucshon, Mr. Bilirakis, and all of you
    for your time, your attention, and your energy to this issue
    because it is an emergency in our country.
        Thank you. I yield back.
        [The prepared statement of Mr. Butterfield follows:]

                  Prepared statement of Hon. G.K. Butterfield

        Chairman Burgess, thank you for the opportunity to address
    the committee today about the state of the opioid epidemic in
    North Carolina.
        I credit my friend and colleague Mary Bono Mack with
    bringing this important topic to the forefront of this
    committee's work to protect public health. As ranking member of
    the subcommittee previously known as Subcommittee on Commerce,
    Manufacturing and Trade, I worked closely with Representative
    Bono Mack to ensure the supply chain for potentially dangerous
    narcotics is airtight.
        Just last year, I worked with many of my colleagues in this
    room on the Comprehensive Addiction and Recovery Act that was
    passed into law. That bill included roughly twenty different
    legislative proposals to help slow the opioid epidemic. As part
    of the 21st Century Cures Act, this committee approved $500
    million in supplemental funding to address opioid abuse.
        Despite the investments and attention from Congress, we are
    still feeling the opioid crisis close to home in North
    Carolina. During the August work period, I saw the effects of
    the epidemic on my community in Wilson, North Carolina.
        Just in August alone, there were two deaths because of
    opioid abuse in Wilson. According to reports in The Wilson
    Times, medics in Wilson County administered Naloxone in
    response to opioid crises 28 times by mid-August, when they
    usually administer the treatment 30 times per quarter.
    According to Chris Parker with Wilson County Emergency Medical
    Services, ``there is a definite increase in opiate use in
    Wilson County.''
        North Carolina has a real problem on its hands. By July of
    this year, there were more than 500 opioid diagnoses for
    emergency department visits, up from 410 at the same point in
    2016.
        Clearly, the administration is not taking this situation
    seriously. The budget offered by the Trump administration cuts
    HHS by 16 percent, the CDC by 17 percent, and that National
    Institutes of Health by 19 percent. I am also very concerned
    about the proposals to gut the Medicaid program that we have
    considered in this very committee. The Center for Budget and
    Policy Priorities estimates that nearly 100,000 people with an
    opioid use disorder have gained coverage through Medicaid
    Expansion under the ACA.
        Congress must do all it can to help stop this epidemic from
    devastating more lives, families, and communities. Congress
    should provide certainty in funding to combat this epidemic,
    which is why I am original cosponsor of H.R. 3495, the Opioid
    and Heroin Abuse Crisis Investment Act of 2017, that was
    introduced by my friend Ben Ray Lujan. We must also protect
    existing funding for research and opioid use disorder coverage,
    provide tools to communities to address this epidemic, and
    reduce stigma for those needing treatment.
        I ask unanimous consent to submit two articles from The
    Wilson Times for the record. I yield back.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Chair recognizes the gentleman from Indiana, Mr. Bucshon,
    for 3 minutes, please.

     STATEMENT OF HON. LARRY BUCSHON, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF INDIANA

        Mr. Bucshon. Chairman Burgess, Ranking Member Green, thank
    you for holding this important hearing today.
        Opioid abuse disorder has ravaged our communities, and
    while it is important to look forward and address what else
    needs to be done to combat this terrible disease, we need to
    ensure the legislation we have already passed is being properly
    implemented and is working as Congress intended.
        In July 2016, the Comprehensive Addiction and Recovery
    Act--CARA--landmark legislation addressing the opioid abuse
    crisis was passed into law. I spent months convening
    stakeholder round tables and working on bipartisan language
    which became Section 303 of CARA.
        Section 303 updates the Controlled Substances Act and
    office-based opioid addiction treatment laws by ensuring that
    patients are offered and physicians are trained on all FDA-
    approved treatments.
        Under previous law, prior to CARA millions of opioid-
    addicted patients had their treatment determined based on their
    setting of care.
        With the passage of CARA, patients in these settings must
    now be offered a full range of treatment options based on their
    individual clinical needs and individualized treatment plan.
        Unfortunately, 15 months after the legislation was signed
    into law, Section 303 still has not been implemented. I urge
    the committee to conduct strong oversight to ensure SAMHSA will
    be properly implementing the law.
        Every day that this law goes unimplemented is one more day
    that our family members, friends, and colleagues are battling a
    disease with fragmented and incomplete treatment options.
        Specifically, SAMHSA should send a dear colleague letter to
    notify physicians that they must offer all anti-addiction
    medicines based on a patient's clinical needs.
        Additionally, curriculum for doctors, PAs, and nurse
    practitioners should be updated to include training on all FDA-
    approved opioid addiction medications.
        Moreover, all of SAMHSA's public-facing material, including
    their Web site, should be modernized to reflect this patient-
    centered approach.
        According to the Evansville Courier and Press, 55 people in
    Vanderbergh County, Indiana, have died of a drug overdose in
    the first nine months of this year, which is more than all of
    2016.
        The availability of all medication-assisted treatments
    regardless of where a patient chooses to seek them will help to
    stem the tide of these unnecessary deaths.
        It is vital that as the committee moves forward in the
    fight against opiate abuse disorder that we ensure CARA is
    properly implemented and helping people combat this terrible
    disease.
        Mr. Chairman, again, thank you for this hearing, and I
    yield back my time.
        [The prepared statement of Mr. Bucshon follows:]

                    Prepared statement of Hon. Larry Bucshon

        Chairman Burgess and Ranking Member Green, thank you for
    holding this important hearing today, Opioid abuse disorder has
    ravaged our communities. and while I it is important to look
    forward and address what else needs to be done to combat this
    terrible disease. we also need to ensure that the legislation
    we have already passed is being properly implemented. and is
    working as intended by Congress,
        In July, 2016, the Comprehensive Addiction and Recovery
    Act, landmark legislation addressing the opioid abuse crisis,
    was passed into law,
        I spent months convening stakeholder roundtables and
    tweaking language on a bipartisan agreement, which became
    section 303 of CARA,
        In particular, Section 303 updates the Controlled
    Substances Act and Office-Based Opioid Addiction Treatment laws
    by ensuring that patients are offered, and physicians are
    trained, on all FDA-approved treatments, Under previous law,
    prior to CARA, millions of opioidaddicted patients had their
    treatment determined based on their setting of care, With the
    passage of CARA, patients in these settings must now be offered
    the full range of treatment options based on their
    individualized clinical needs,
        Unfortunately, 15 months after the legislation was signed
    into law, Section 303 still has not been implemented. I urge
    the committee to conduct strong oversight to ensure SAMHSA will
    be properly implementing the law, Every day that this law goes
    unimplemented, is one more day that our family members,
    friends, and colleagues are battling a disease with fragmented
    and incomplete treatment options,
        Specifically, SAMHSA should send a Dear Colleague letter to
    notify physicians that they must offer all anti-addiction
    medicines based on a patient's clinical needs, Additionally,
    curriculum for doctors, PAs, and nurse practitioners should be
    updated to include training on all FDA-approved opioid
    addiction medications, Moreover, all of SAMHSA's public facing
    material should be modernized to reflect this patient-centered
    approach,
        According to the Evansville Courier and Press, 55 people in
    Vanderburgh County, IN have died of a drug overdose in the
    first nine months of this year, which is more than all of 2016.
    The availability of all medication-assisted treatments,
    regardless of where a patient chooses to seek them, will help
    to stem the tide of these unnecessary deaths.
        It's vital that as the committee moves forward in the fight
    against opioid abuse disorder that we ensure the hard work that
    the committee has already accomplished is implemented and
    working.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman and recognizes the gentleman from Ohio, Mr. Latta,
    for 3 minutes, please.

    STATEMENT OF HON. ROBERT E. LATTA, A REPRESENTATIVE IN CONGRESS
                         FROM THE STATE OF OHIO

        Mr. Latta. Well, thank you, Mr. Chairman, and again, thank
    you for holding this hearing today.
        Opioid abuse and addiction has caused devastation in every
    community across our Nation and Ohio has been especially hard
    hit. In Ohio, in 2015, 3,050 people lost their lives from
    unintentional drug overdose.
        In 2016, that number increased to 4,050. That's a 32
    percent increase from the previous year and that means 11
    deaths a day. For comparison, in 2016, there were 1,133 traffic
    fatalities in Ohio.
        That means that drug overdoses cause nearly four times as
    many deaths compared to traffic accidents. These figures are
    heartbreaking and sad to know that this problem isn't getting
    any better.
        Many county coroners in Ohio say that 2017's overdose
    fatalities are outpacing 2016's. This problem knows no limits
    and has affected husbands, wives, children, brothers, sisters,
    fathers, and mothers. It has destroyed marriages, ruined
    careers, and cut too many lives short.
        When I read through the obituaries in my local newspapers
    over the past year or two I have noticed more younger
    individuals without a cause of death being listed.
        Unfortunately, in too many of instances it is because of
    drug overdoses. Across my district in northwest and west
    central Ohio, I have heard how opioid addiction impacts our
    communities.
        I have toured businesses and met with community leaders and
    spoke with families to hear how substance use disorders have
    directly affected their lives.
        It is because of these stories that I plan to introduce
    legislation that would direct the Department of Health and
    Human Services to create a public electronic database of
    information relating to nationwide efforts to combat the opioid
    crisis.
        The database would serve as a central location of
    information for the public and others to track Federal funding
    allocations made available for research and treatment of opioid
    abuse, find research relating to opioid abuse from all Federal
    agencies, State, local, and Tribal governments as well as
    nonprofits, law enforcement, medical experts, public health
    educators, and research institutes.
        Furthermore, the legislation would charge HHS to evaluate a
    myriad of issues relating to pain management, addiction,
    prescription guidelines, treatments, trends and patterns, and
    effective solutions to problems used across the country.
        These findings would be available on the database as well
    and HHS would be instructed to offer recommendations for
    targeted areas of improvement.
        I believe that with the help of HHS and other relevant
    agencies this database will allow for easier access of
    information, funding streams, and relevant data that can help
    to combat the opioid abuse epidemic across our Nation.
        With 11 people dying every day in Ohio and over 91
    Americans dying nationwide every day, we have run out of time
    to find a solution to this crisis. We need action now.
        I appreciate the committee for holding this forum to
    express creative ideas and solutions and hope it leads to more
    lives being saved.
        Mr. Chairman, I appreciate the opportunity to be here, and
    I yield back the balance of my time.
        [The prepared statement of Mr. Latta follows:]

                   Prepared statement of Hon. Robert E. Latta

        Opioid abuse and addiction has caused devastation in every
    community, and Ohio has been hit especially hard.
        In 2016, Ohio lost at least 4,050 people from unintentional
    drug overdose. That's a 32 percent increase from the previous
    year and 11 deaths a day.
        For comparison, in 2016, there were 1,133 traffic
    fatalities in my State. That means drug overdoses caused nearly
    4 times as many deaths compared to traffic accidents.
        These figures are heartbreaking and it's sad to know that
    this problem isn't getting any better. Many coroners say that
    2017's overdose fatalities are outpacing 2016's.
        This problem knows no limits and has affected husbands,
    wives, children, brothers, sisters, fathers, and mothers. It
    has destroyed marriages, ruined careers, and cut lives far too
    short.
        I frequently read obituaries in my local newspaper, and
    over the past year or two I started to notice a pattern of
    younger individuals without a cause of death. I soon realized
    that no cause was listed because they had died from a drug
    overdose. This happens far too often.
        All across my district in Northwest and West Central Ohio,
    I've heard how opioid addiction impacts our communities. I've
    toured businesses, met with community leaders, and spoke with
    families to hear how substance use disorders have directly
    affected their lives.
        It's because of these stories that I plan to introduce a
    bill that will direct the Department of Health and Human
    Services to create a public electronic database of information
    relating to nationwide efforts to combat the opioid crisis.
        The database would serve as a central location of
    information for the public and others to:
         Track Federal funding allocations made available
    for research and treatment of opioid abuse; and,
         Find research relating to opioid abuse from all
    Federal agencies, State, local, and Tribal governments, as well
    as nonprofits, law enforcement, medical experts, public health
    educators, and research institutes.
        Furthermore, my bill would charge HHS to evaluate a myriad
    of issues relating to pain management, addiction, prescription
    guidelines, treatments, trends and patterns, and effective
    solutions and programs used across the country.
        These findings would be available on the database as well
    and HHS would be instructed to offer recommendations for
    targeted areas of improvements.
        I hope that with the experts at HHS, and other relevant
    agencies, this database will allow for easier access of
    information, funding streams, and relevant data that can help
    to combat the opioid abuse epidemic across our country.
        With 11 people dying every day in my home State of Ohio,
    and over 91 Americans dying every day nationwide, we have run
    out of time to find a solution to this crisis. We need action
    now.
        I appreciate the committee for holding this forum to
    express creative ideas and solutions, and hope it leads to
    lives being saved.

        Mr. Burgess. Chair thanks the gentleman. The gentleman
    yields back.
        The Chair wants to thank all the Members on this panel for
    your testimony. You are now excused, and we will seek the next
    panel, and I----
        Mr. Butterfield. Mr. Chairman, a parliamentary inquiry.
    Did----
        Mr. Burgess. The gentleman will state his parliamentary
    inquiry.
        Mr. Butterfield. I am not sure that is the right
    terminology. But I wanted to include into the record two
    newspaper articles that I referenced.
        Have I lost my right to do that?
        Mr. Burgess. Is the gentleman asking unanimous consent?
        Mr. Butterfield. I am. Yes, sir.
        Mr. Burgess. Without objection, so ordered.
        [The information appears at the conclusion of the hearing.]
        Mr. Butterfield. Thank you.
        Mr. Burgess. And the Chair now would ask that the next
    panel, which is Mr. Johnson, Mr. Welch, Leader Pelosi, and Mrs.
    Brooks.
        And, again, members of the committee are welcome to provide
    their testimony from their seated position on the dais or from
    the witness table, whichever is your preference.
        And, Mr. Johnson, I will recognize you for 3 minutes.

     STATEMENT OF HON. BILL JOHNSON, A REPRESENTATIVE IN CONGRESS
                         FROM THE STATE OF OHIO

        Mr. Johnson. Thank you, Mr. Chairman. I appreciate this
    discussion about an issue that is so vitally important.
        It is no secret that America is in the midst of an opioid
    crisis. Last year, in my home State of Ohio alone, about 86
    percent of overdose deaths involved an opioid.
        This epidemic can be felt in virtually every community
    across the country and today I want to share a story that will
    shed some light on some of the good work being done by people
    in my district to help combat the opioid epidemic and to
    perhaps let everyone know about some of the positive things
    that are taking place.
        Recently, I had the honor of visiting Field of Hope, a
    faith-based nonprofit treatment facility in southeastern Ohio
    that assist area families ravaged by poverty and drug abuse.
        Field of Hope Recovery House was founded by a man named
    Kevin Dennis after he witnessed his own daughter become
    addicted to opioids after she had knee surgery from a high
    school athletic injury.
        Her prescriptions ran out before her pain was managed. But,
    unfortunately, by that point, she was addicted. She ended up in
    prison several times for theft and checked into numerous rehab
    facilities before she fully recovered from addiction.
        She is now a recovery counselor at Field of Hope and is
    happily married with a child. I heard some incredibly powerful
    and touching stories during my visit to the Field of Hope
    Campus and I witnessed the good work they are doing firsthand.
        We, in Congress, and especially in this committee have an
    important role to play in supplementing and enabling the work
    being done by organizations like Field of Hope.
        On the front end, we need to develop prevention policies
    that steer people like Kevin's daughter away from opioids in
    the first place. Innovative nonopioid nonaddictive treatments
    exist today and more are on the way. But this--these innovative
    treatments are not always covered by Federal programs like
    Medicare and Medicaid.
        We should closely examine the reimbursement policies in
    place to ensure that patients have access to effective
    alternatives for pain management without the risk of addiction.
        I've also been encouraged by recent efforts by private
    payers, providers, pharmacists, and patient groups to address
    the addiction crisis through increased awareness, prescribing
    guidelines, and new treatment options. I believe Congress can
    play a role in ensuring that all prescribers are equipped with
    education in pain management so they can provide effective pain
    treatments for patients and timely intervention for those who
    are addicted.
        I look forward to continuing to work with my colleagues on
    the committee and in the House to find effective solutions to
    this scourge.
        Mr. Chairman, it is a national crisis. We need to act, and,
    with that, I yield back the balance of my time.
        [The prepared statement of Mr. Johnson follows:]

                    Prepared statement of Hon. Bill Johnson

        It is no secret that the United States is in the midst of
    an opioid epidemic. Last year, in my home State of Ohio alone,
    about 86 percent of overdose deaths involved an opioid. This
    epidemic can be felt in virtually every community across the
    country; and today, I want to share a story that will shed some
    light on some of the good work being done in my district to
    help combat the opioid epidemic, and to let people know about
    some of the positives taking place.
        I had the honor of visiting Field of Hope, a faith-based,
    nonprofit, treatment facility in Southeastern Ohio that assists
    area families ravaged by poverty and drug abuse. Field of Hope
    recovery house was founded by a man named Kevin Dennis, after
    he witnessed his own daughter become addicted to opioids after
    she had knee surgery from a high school athletic injury. Her
    prescriptions ran out, but she was addicted. She ended up in
    prison several times for theft, and checked into numerous rehab
    facilities before she fully recovered from addiction. She is
    now a recovery counselor at Field of Hope, and is happily
    married with a child. I heard some incredibly powerful and
    touching stories during my visit to the Field of Hope campus,
    and I witnessed the good work they are doing firsthand.
        We in Congress, and especially in this committee, have an
    important role to play in supplementing and enabling the work
    being done by organizations like Field of Hope. On the front
    end, we need to develop prevention policies that steer people,
    like Kevin's daughter, away from opioids in the first place.
    Innovative nonopioid treatments exist today, and more are on
    the way, but are not always covered by Federal programs like
    Medicare and Medicaid. We should closely examine the
    reimbursement policies in place to ensure that patients have
    access to effective alternatives for pain management without
    the risk of addiction.
        I've also been encouraged by recent efforts by private
    payers, providers, pharmacists, and patient groups to address
    the addiction crisis through increased awareness, prescribing
    guidelines, and new treatment options. I believe Congress can
    play a role in ensuring that all prescribers are equipped with
    an education in pain management so they can provide effective
    pain treatments for patients and timely intervention for those
    who are addicted.
        I look forward to continuing to work with my colleagues on
    the committee and in the House to find effective solutions to
    this scourge.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        The Chair is then pleased to recognize the entire Vermont
    delegation. Mr. Welch, you are recognized for 3 minutes.

      STATEMENT OF HON. PETER WELCH, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF VERMONT

        Mr. Welch. We don't have the numbers of Texas, but I
    appreciate the recognition.
        First of all, Dr. Burgess, thank you, and Mr. Green, thank
    you--your taking time to focus attention and demonstrate the
    urgency of this challenge.
        Second, this so affects us all. I mean, it's heartbreaking
    and it doesn't matter whether it's a red district or a blue
    district. It doesn't matter what your view is on the size and
    scope of Government. This is hurting people in your district,
    Dr. Burgess and Mr. Green, and in my district and my
    colleagues' here.
        In Vermont, our Governor dedicated his entire State of the
    State Address to this epidemic in 2014, and I remember at that
    time many of my colleagues asked the question, ``Peter, isn't
    this going to do bad things for the reputation of Vermont,''
    but then acknowledged that what he was saying was true in their
    own State--in their own districts.
        So you focussing attention on it, Mr. Chairman, thank you.
    That is step number one. I can give you some statistics in
    Vermont but they would be very similar to Mr. Johnson.
        I mean, our prescription drug problems with individuals
    increased from 2,477 in 2012 by 80 percent. Heroin went from
    913 in 2012 and increased to 3,488--a 380 percent increase.
    Every one of those stories is a story of family heartache.
        I mean, I got a letter from a mom whose 27-year-old son
    became addicted to heroin and just the story about him being
    homeless, him going from being a full time working person to
    being out on the street, him--her having to call her daughters,
    saying that their brother may soon be dead--all of that is real
    and all to vivid.
        So this is an enormous challenge. Our job in Congress is to
    come up with some policies that are going to help people help
    themselves and I would like to make a few suggestions of things
    that we need to do.
        Number one, we do have to have funding. We have to have
    full funding for the Comprehensive Addiction and Recovery Act,
    and we've got to find the money in order to allow our
    communities to do that work.
        Two, we have to have more research into alternative
    treatment. I am working with Mr. McKinley to try to get the
    Comprehensive Addiction and Recovery Act to find better
    alternatives to treat pain.
        Three, let us allow for partial filling of opioid
    subscriptions. Many of us have signed letters that would allow
    that to happen.
        Four, let's support the recent action by Commissioner
    Gottlieb. He has done some good things. Immediate release--he
    is trying to get immediate release opioid manufacturers to
    follow a more stringent set of REMS requirements which includes
    training doctors to safely prescribe these drugs.
        So this hearing is tremendous--focusing attention. The next
    step is to put this into legislative action.
        Thank you, Mr. Chairman.
        [The prepared statement of Mr. Welch follows:]

                     Prepared statement of Hon. Peter Welch

        First of all, Dr. Burgess, thank you, and Mr. Green, thank
    you, you're taking time to focus attention and demonstrate the
    urgency of this challenge. Second, this so affects us all, I
    mean it's heartbreaking, and it doesn't matter if it is a red
    district or a blue district, it doesn't matter what your view
    is on the size and scope of Government. This is hurting people
    is your district Dr. Burgess and Mr. Green, and in my district
    and my colleagues' here.
        In Vermont, our Governor dedicated his entire State of the
    State address to this epidemic in 2014, and I remember at that
    time many of my colleagues asked the question `Peter, isn't
    this going to do bad things for the reputation of Vermont?' but
    then acknowledged that what he was saying was true in their own
    State, in their own districts. So you focusing attention on it
    Mr. Chairman, thank you, that is step number one.
        I can give you some statistics in Vermont, they would be
    very similar to Mr. Johnson. I mean our prescription drug
    problems with individuals increased from 2,477 in 2012 by 80
    percent, heroin went from 913 in 2012 and increased to 3,488, a
    380 percent increase. Every one of those stories is a story of
    family heartache. I mean, I got a letter from a mom whose 27-
    year-old son became addicted to heroin, and just the story
    about him being homeless, him going from being a full time
    working person to being out on the street, her having to call
    her daughters saying that their brother may soon be dead. All
    of that is real and all too vivid. So this is an enormous
    challenge.
        Our job in Congress is to come up with some policies that
    will help people help themselves. And I'd like to make a few
    suggestions of things that we need to do. Number one, we do
    have to have funding. We have to have full funding for the
    Comprehensive Addiction and Recovery Act. And we have got to
    find the money to in order allow our communities to do that
    work. Two, we have to have more research into alternative
    treatment. I'm working with Mr. McKinley to try to get the
    Comprehensive Addiction and Recovery Act to find better
    alternatives to treat pain. Three, let's allow for partial
    filling of opioid prescriptions. Many of us have signed letters
    that would allow that to happen. Four, let's support the recent
    action by commissioner Gottlieb. He's done some good things. He
    is trying to get immediate release opioid manufacturers to
    follow a more stringent set of REMS requirements, which
    includes training doctors to safely prescribe these drugs. So,
    this hearing is tremendous, focusing attention. The next step
    is to put this into legislative action.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        The Chair recognizes the gentlelady from Indiana, Mrs.
    Brooks, for 3 minutes, please.

    STATEMENT OF HON. SUSAN W. BROOKS, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF INDIANA

        Mrs. Brooks. Thank you, Mr. Chairman, and thank you,
    Ranking Member Green, for hosting this incredibly important
    hearing.
        Too many Americans are struggling with the crippling
    effects of drug abuse and addiction and the statistics, as we
    know, are devastating.
        According to the Indiana State Department of Health, every
    2 1A\1/2\ hours, a Hoosier is sent to the hospital for an
    opioid overdose.
        Across our State there are enough bottles of painkillers in
    circulation for nearly every Hoosier to have their own and the
    number of infants born addicted to opioids is increasing at an
    alarming rate with health care costs for these babies costing
    Indiana more than $64 million in 2014 alone.
        And as we know, like so many other States, Hoosiers are now
    more likely to die from a drug overdose than a car accident.
        When I came to Congress in 2013, I had been very focussed
    on our communities and families that this epidemic has swept
    up. And like so many of my colleagues, we have held round
    tables. We have held meetings. We have met with addicted
    individuals' families. We have been on the front line with
    prescribers, health care workers. We all agree this is a
    Federal problem and a local problem.
        Last year, we passed CARA, which included my bill to
    establish an interagency task force to review, modify, and
    update the best practices for pain management and prescribed
    pain medicine.
        HHS has already taken steps informing this task force, but
    more needs to be done. In my view, it is critical to ensure
    that the medical professionals have continuing medical
    education for the prescribing of DEA-controlled substances that
    have such a high risk of abuse.
        I am exploring options to ensure that physicians and other
    medical professionals who prescribe these schedule drugs have
    more and better education linked to the application and renewal
    of their DEA licenses.
        Professionals who prescribe and dispense opioid medications
    must have better training so that they fully understand those
    patients who, sadly, have gotten the onset of addiction due to
    what they've been prescribed and now they need even better
    education to help prevent that onset and then to help them with
    the addiction.
        Indiana is tackling our problems head on and in fact just
    yesterday Indiana University announced a new initiative called
    Responding to the Addictions Crisis. It is being led by IU's
    Dean of Nursing, Robin Newhouse. IU is committing $50 million
    over the next 5 years to collaborate with State and community
    partners to tackle this crisis.
        It is going to be one of the most comprehensive State-based
    responses and every IU campus in the State is going to be
    involved.
        It is going to focus on training and education, data
    collection and analysis, policy analysis and development,
    addiction sciences, community and workforce development.
        So major steps are being taken across our State because
    everyone has a role to play, from our prescribers to our
    medical, to our higher ed institutions.
        And I want to remind folks that DEA has a national
    prescription drug take-back day. It is approaching on October
    28th.
        It provides that safe, convenient, responsible way to
    dispose of excess prescriptions drugs so that people can get
    those drugs out of their medicine cabinets and out of our kids'
    reach. And not just kids--to adults. So there are going to be
    locations all across the country and I really encourage
    everyone because everyone has a role to play. And so October
    28th is National Take-Back Day and I hope that we get that word
    out.
        Thank you, Mr. Chairman. I yield back.
        [The prepared statement of Mrs. Brooks follows:]

                   Prepared statement of Hon. Susan W. Brooks

        Thank you, Mr. Chairman.
        Too many Americans are struggling with the crippling
    effects of drug addiction and abuse and too many families are
    grieving the loss of a loved one to an overdose. Since I joined
    Congress in 2013, I have been committed to helping people
    overcome this sweeping epidemic. According to the Indiana State
    Department of Health, every 2 1A\1/2\ hours, a Hoosier is sent
    to the hospital for an opioid overdose. Across the State there
    are enough bottles of painkillers in circulation for nearly
    every Hoosier to have their own. The number of infants born
    addicted to opioids is increasing at an alarming rate, costing
    Indiana more than $64 million in 2014 alone. Hoosiers are now
    more likely to die from a drug overdose than a car accident;
    Indiana is one of four States where the fatal drug overdose
    rate has quadrupled since 1999, ranking us 15th in the country
    in overdose fatalities.
        At home in the district, I have pursued answers to this
    epidemic through roundtables and meetings with individuals and
    families on the front lines of this crisis, prescribers and
    health workers and first responders, and community leaders. I
    have visited the neonatal intensive care unit (NICU) at Saint
    Vincent's Hospital in Indianapolis to see firsthand the
    devastating effects of infants born addicted to opioids and who
    must already fight for survival through withdrawal in their
    very first days on this earth. I meet with juvenile court
    judges and social workers whose caseloads have doubled as more
    and more children are being removed from their parents' care
    because their parents are more concerned about where to find
    their next high than the welfare of their child and it is no
    longer safe for them in their home. Indiana first responders
    tell me they are overwhelmed with the unprecedented increase in
    drug overdoses.
        Last year Congress passed the Comprehensive Addiction and
    Recovery Act which included significant resources and reforms
    to combat this crisis; the measure included my bill to
    establish an inter-agency task force to review, modify, and
    update best practices for pain management and prescribe pain
    medicine. Although we've made great strides to turn the tide of
    the epidemic, we need to do more to bring prescribers in as
    part of the solution and help educate people struggling with
    substance abuse and their families.
        Just a few months ago, I met with the Grant County
    Substance Abuse Task Force at Marion General Hospital and heard
    from community leaders how important it is to fight this crisis
    at a Federal AND local level. In order to do this, it is
    critical that our first responders have the equipment they need
    to safely respond to situations where toxic substances are
    present. We must also educate the youngest members of our
    communities of the dangers of substance abuse, and ensure our
    kids do not have access to harmful prescription drugs. As part
    of my ongoing effort to combat this crisis, I will be
    participating in the DEA's National Prescription Drug Take Back
    Day on October 28. This provides a safe, convenient, and
    responsible way to dispose of excess prescription drugs, while
    also providing an opportunity to raise awareness of the opioid
    crisis and to educate our friends, family members, and
    neighbors about the potential for abuse of medications.
        Indiana is tackling the problem head-on. I trust our State
    and local partners to do what's necessary to address this
    crisis and it is a priority for Governor Holcomb. He recently
    established a Commission to Combat Opioid Abuse and, just
    yesterday, Indiana University announced it committing an
    investment of $50 million to collaborate with State and
    community partners to tackle this crisis, making it one of the
    Nation's largest and most comprehensive State-based responses.
    Major steps are being taken across the State, proving that it
    will take everyone--from the Federal Government to individuals
    in our communities--do their part to combat this crisis.
        Thank you, Mr. Chairman, and I yield back.

        Mr. Burgess. Very well, and of course, I thank the
    gentlelady for providing the date. This hearing is being
    streamed on Facebook Live, so your information now has been
    distributed to everyone who's been tuning in this morning. So
    that is a good thing, and perhaps we can each individually try
    to make that date part of our discussions as we go through the
    rest of the month.
        I want to thank this panel for being here. You all are
    excused. I have a panel identified of Mr. Lujan, Markwayne
    Mullin of Oklahoma, Mr. Tonko, Mr. Hudson, and Mr. Kennedy.
        Again, Energy and Commerce members are advised that they
    may present from the dais or from the witness table, whichever
    is your preference.
        If you are seated at the table, we will provide a name tag
    for you. So, whenever you are ready, Mr. Lujan, you are
    recognized for 3 minutes, please.

     STATEMENT OF HON. BEN RAY LUJAN, A REPRESENTATIVE IN CONGRESS
                      FROM THE STATE OF NEW MEXICO

        Mr. Lujan. Thank you, Mr. Chairman. I thank the chairs and
    ranking members for the opportunity to discuss how New Mexico
    has been impacted by the opioid crisis.
        Five hundred and one New Mexicans died of drug overdose
    deaths in 2015. Across this country, there were 52,404 deaths
    in 2015 and more than 560,000 deaths between 1999 and 2015--a
    half a million people who missed Thanksgiving dinner or their
    daughter's softball game, who weren't able to help their son
    with math homework or kiss their spouse good night.
        That's brothers and sisters, parents and friends and
    children that we have lost too soon because in part Congress
    has not responded forcefully enough to the crisis.
        Last Congress, we did important work by passing the
    Comprehensive Addiction and Recovery Act--CARA--and 21st
    Century Cures Act. These were steps in the right direction but
    these efforts alone are not enough.
        I have heard from my community that the funding passed in
    Cures is helpful but hard to use. In part, this is because of
    the short funding period which impacts communities' ability to
    plan for the long-term and expand capacity.
        We know that in two many areas like New Mexico there are
    simply not enough people and resources. Many want help and
    can't get it.
        I am reminded of a story relayed to me by one of my
    constituents, Jay, who have stopped using heroin on his own--
    who felt as if he was going into relapse and sought help at a
    local treatment facility.
        Jay was told, come back when you are using. He was turned
    away and told to come back only if he started using again
    because they lacked the capacity to treat patients who were not
    active drug users. That's simply not right.
        To really expand the treatment prevention and wraparound
    services that our constituents need, we must increase funding
    and create stability. We need to give local governments and
    organizations the ability to plan and not fear losing vital
    support from Congress.
        Most of all, we need to give constituents like Jay a place
    to go after he's fought a tough fight on his own. That's why I
    introduced the Opioid and Heroin Abuse Crisis Investment Act to
    continue the funding to combat the opioid epidemic we passed in
    21st Century Cures for an additional 5 years.
        I would welcome my colleagues' support because we
    absolutely must extend this funding for an additional 5 years
    and beyond.
        However, this still isn't enough, which is why we must look
    at new efforts to drive vital investments to help those in need
    and address the barriers to appropriate quality and accessible
    treatment.
        These barriers include a decaying rural mental health and
    substance abuse treatment infrastructure, lack of regional
    coordination of treatment resources, lack of support for rural
    physicians providing substance abuse treatment, administrative
    barriers against the most effective form of opioid abuse
    treatment, and a shortage of rural physicians who provide
    medication-assisted treatment.
        We as a committee must recognize that hoping for the best
    is not valid public policy--there is a quick fix to solve the
    opioid crisis. That is simply not true.
        We need to advance serious legislation that takes into
    account long-term planning for the Federal Government and for
    States and communities. We need to bring it to the floor of the
    House, send it to the Senate, get it passed, and to the
    president's desk.
        I fear that until we recognize this fact we will continue
    to lose brother's and sisters, parents and friends, and
    children.
        Mr. Chairman, I thank you for holding this important
    hearing and finding a way for us to work in a bipartisan
    fashion to address this important issue.
        Thank you, Mr. Chairman. I yield back.
        [The prepared statement of Mr. Lujan follows:]

                    Prepared statement of Hon. Ben Ray Lujan

        I thank the chairs and ranking members for the opportunity
    to discuss how New Mexico has been impacted by the opioid
    crisis.
        Five hundred and one New Mexican died of drug overdoses
    deaths in 2015.
        Across this county, there were 52,404 deaths in 2015 and
    more than 560,000 deaths between 1999 and 2015.
        A half million people who missed Thanksgiving dinner, or
    their daughter's softball game. Half-a-million who weren't able
    to help their son with their math homework or kiss their spouse
    goodnight.
        That's brothers, sisters, parents, friends, and children
    that we lost too soon because, in part, Congress has not
    responded forcefully enough to this crisis.
        Last Congress, we did important work by passing the
    Comprehensive Addiction and Recovery Act (CARA), and 21st
    Century Cures Act.
        These were steps in the right direction, but these efforts
    alone are not enough.
        I've heard from my community that the funding passed in
    21st Century Cures is helpful, but hard to use. In part, this
    is because of the short funding period, which impacts
    communities' ability to plan for the long-term and expand
    capacity.
        We know that in too many areas like New Mexico, there are
    simply not enough people and resources. Many want help and
    can't get it.
        I am reminded of a story relayed to me by one of my
    constituents, Jay, who had stopped using heroin on his own, but
    felt as if he was going to relapse and sought help at a local
    treatment facility.
        Jay was turned away and told to come back only when he
    started using again, because they lacked the capacity to treat
    patients who were not active drug users. That's simply not
    right.
        To really expand the treatment, prevention, and wrap around
    services that our constituents need, we must increase funding
    and create stability.
        We need to give local governments and organizations the
    ability to plan--and not fear losing vital support from
    Congress. Most of all we need to give Jay a place to go after
    he's fought a tough fight on his own.
        That is why I introduced the Opioid and Heroin Abuse Crisis
    Investment Act to continue the funding to combat the opioid
    epidemic we passed in 21st Century Cures for an additional 5
    years. I would welcome my colleagues support because we
    absolutely must extend this funding for an additional 5 years
    and beyond.
        However, this still isn't enough, which is why we must look
    at new efforts to drive vital investments to help those in need
    and address the barriers to appropriate, quality, and
    accessible treatment.
        These barriers include a decaying rural mental health and
    substance abuse treatment infrastructure, lack of regional
    coordination of treatment resources, lack of support for rural
    physicians providing substance abuse treatment, administrative
    barriers against the most effective form of opioid abuse
    treatment, and a shortage of rural physicians who provide
    Medication Assisted Treatment.
        We as a committee must recognize that `hoping for the best'
    is not valid public policy. There is no quick-fix to solve this
    opioid epidemic.
        We need to advance serious legislation that takes into
    account long-term planning for the Federal Government, and for
    States and communities. We need to bring it to the floor of the
    House, and we need to send it to the President's desk.
        I fear that until we recognize this fact, we will continue
    to lose brothers, sisters, parents, friends, and children.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        Mr. Mullin, you are going to be recognized for 3 minutes.
    After that, we will allow the Minority Leader to be seated at
    the table and hear her testimony.
        But Mr. Mullin, go ahead for 3 minutes, please.
        Mr. Mullin. OK. Mr. Chairman, I have no problem with
    letting Ms. Pelosi go next, if she would like to.
        Mr. Burgess. If the Minority Leader is ready, then, yes, we
    will recognize you for--you are recognized.

     STATEMENT OF HON. NANCY PELOSI, A REPRESENTATIVE IN CONGRESS
                      FROM THE STATE OF CALIFORNIA

        Ms. Pelosi. Thank you, Mr. Chairman. Thank you, Rep.
    Mullin, for your courtesy. I really came to listen as well as
    to convey some thoughts.
        This is only the second time I've ever testified as Leader
    or as--in that capacity because this issue rises to the level,
    as you know, of life and death. And so, with gratitude to you
    and to the ranking member, Mr. Green, for bringing us together
    in a bipartisan way on this issue that is a matter of life and
    death.
        Thank you, Mr. Burgess.
        The opioid epidemic, again, is taking a savage daily toll
    on the American people. We know that, and regardless of who
    they are or where they live, they are in every district in the
    country, as we know.
        The scourge is tearing families apart, have an impact on
    the well-being of our children, hollowing out communities. It
    has claimed the lives of tens of thousands of Americans every
    year, on average robbing 91 people of their lives each day.
        Again, just to testify to that--I know it's a matter of
    your record here. Opioid addiction is a public health
    catastrophe and is growing more dire and deadly every day.
        And I believe that it is really important for us to respond
    to this national emergency with the seriousness and urgency it
    requires. Fortunately, we have had bipartisanship in passing
    legislation--the Comprehensive Addiction and Recovery Act.
        We all came together during the bipartisan legislation that
    was passed--the 21st Century Cures Act that people were so
    happy that the addiction language was in there. That day we
    heard the stories of families so affected--break your heart--
    families who had lost a child, a young teenager or 21-year-old
    or whatever within a matter of days or weeks before that
    particular signing.
        President Obama signed that legislation. But it had the
    language. It just hasn't had the money to the adequate extent
    and that, Mr. Chairman, is my appeal to you for our Democrats
    and Republicans to work together to have the funding to fund
    the key initiatives authorized in the bill.
        I do want to make a pitch for Medicaid be built on the
    progress. The ACA's Medicaid expansion has provided a vital
    lifeline for tens of thousands of Americans struggling with
    addiction.
        As Governor of Ohio, our former colleague, John Kasich,
    noted, thank God we expanded Medicaid, because that Medicaid
    money is helping to rehab people.
        Yet 19 States have not taken that step. We stand ready to
    work with you, Mr. Chairman, in good faith with Republicans to
    update and improve the ACA but we remain vigilant against
    efforts to gut Medicaid because it will create even more of a
    problem in terms of opioids, just to name one thing.
        The opiate epidemic is a challenge to the conscience of the
    entire country. We must, again, act urgently and boldly to get
    America's families the prevention treatment and recovery
    resources they need, and in that regard I said we must work
    with providers in the pharmaceutical industry to push effective
    prevention measures so we can reduce unnecessary prescriptions
    and stop this epidemic at the source.
        Knowing of your busy schedule, I will submit my entire
    statement for the record. Again, thank you for the courtesy of
    being able to testify before your committee and thank you for
    your leadership on this important issue, and thank you, Mr.
    Green, as well.
        [The prepared statement of Ms. Pelosi follows:]

                    Prepared statement of Hon. Nancy Pelosi

        Thank you all for being here to shine a light on the
    devastating epidemic of opioid addiction.
        Opioid addiction is inflicting a savage daily toll on
    Americans--regardless of who they are, where they live or how
    much money they make.
        This scourge is tearing apart families and hollowing out
    communities. It is claiming the lives of tens of thousands of
    Americans every year--robbing an average of 91 people of their
    lives each day and driving down the national life expectancy.
        Opioid addiction is a public health catastrophe. And it is
    growing more dire and deadly each day.

                             Serious, Urgent Action

        We must respond to this national emergency with the
    seriousness and urgency it requires.
        We must increase funding and improve capacity, so that
    health systems and providers can offer high-quality, evidence-
    based opioid addiction treatment, including medication-assisted
    treatment and recovery support services.
        It is unacceptable that our Nation lacks the capacity to
    treat nearly half of the men and women who suffer from opioid
    use disorders;
        We must also improve access to treatment--combatting the
    stigmas, cost and misperceptions that prevent people from
    accessing care.
        And we must work with providers on effective prevention
    measures--so we can limit opioid supply, and stop this epidemic
    at the source.

                                  CARA Funding

        Fortunately, Congress has already created the tools to
    improve prevention and expand access to care.
        Last year, Democrats and Republicans worked together to
    pass the Comprehensive Addiction and Recovery Act--a landmark
    bill to provide the full continuum of care to those suffering
    from opioid addiction.
        But, unfortunately, the Republican Congress has so far
    failed to adequately fund the key initiatives authorized by
    this bill.
        There is no room for politics in the life-or-death fight
    against opioid addiction. We cannot shortchange the resources
    needed to fight the tragedy of opioid addiction in our country.
        Congress is appropriating billions to rebuild communities
    after natural disasters--we must show a similar commitment to
    rebuilding communities ravaged by opioids.

                             ACA Medicaid Expansion

        We must also build on the progress of the ACA's Medicaid
    expansion, which has provided a vital lifeline for tens of
    thousands of Americans struggling with opioid addiction.
        As Ohio Governor John Kasich noted, ``Thank God we expanded
    Medicaid, because that Medicaid money is helping to rehab
    people.''
        Yet, 19 States still have not taken the step of extending
    the life-saving benefits of Medicaid coverage. We must work
    with States to expand Medicaid, so we can bring urgently needed
    care to men and women fighting for their lives.
        Democrats stand ready to work in good faith with
    Republicans to update and improve the ACA. But we will remain
    vigilant against any effort to gut Medicaid or create higher
    costs for less care for families.

                                     Close

        The opioid epidemic is a challenge to the conscience of the
    entire country.
        We must act urgently and boldly to get America's families
    the prevention, treatment and recovery resources they need.
    Thank you, all, for your leadership in this fight.

        Mr. Burgess. The Chair thanks the Minority Leader for being
    here today. You are welcome to stay and listen to the testimony
    of the other Members, but we also respect your schedule, and if
    you need to leave, that is certainly understandable as well.
        But in the meantime, I will recognize Mr. Mullin for 3
    minutes.
        Ms. Pelosi. Thank you for your hospitality. I will listen.
    I will listen.
        Mr. Burgess. Well, yes, I will recognize the gentleman from
    Texas.
        Mr. Green. Thank you, Leader, for being here. But before
    Mr. Mullin testifies, Mr. Chairman, I would like to thank him
    for his work.
        Literally, when the water was going down in Houston, you
    called me and said, ``I have some churches in Tulsa who want to
    partner with your churches.''
        So we did that, and instead of having one week's worth of
    your folks from your Cherokee Nation, I think they stayed a
    month, helping my seniors and disabled clean out their 3 or 4
    feet of water in their house, and I didn't realize they had
    that drywall skills. So thank you.
        Ms. Pelosi. As one with a daughter in Houston, and
    grandchildren, I thank you as well.
        Mr. Mullin. Thank you.

        STATEMENT OF HON. MARKWAYNE MULLIN, A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF OKLAHOMA

        Mr. Mullin. Mr. Green, thank you. Cherokee Nation called us
    right off the bat and said, ``How can we help?,'' and we had
    churches reach out to us, and we have been very fortunate to
    work together on multiple issues here in Congress. It has been
    a friendship that carried past that and it was a--it was an
    honor to be able to help your constituents.
        Thank you, Mr. Chairman and Mr. Green, for allowing us to
    talk about such an important epidemic that is going across our
    Nation. We talk often about the opioid epidemic. But what are
    we talking about as far as how did we get here and then how do
    we go back.
        We never want to talk about taking medicine backwards. But
    I stand--I sit in front of you, from a gentleman who's had
    surgeries since I was a little boy. I was born with my hips out
    and my feet in club--in the club feet position and I started
    having surgeries very young. I also built up a very large pain
    tolerance. And I have never been one to use pain medicine.
        Now, my wife says that I am different than most. I think
    most people in this room would probably agree with that. But I
    do understand pain, and I understand the need for medicine.
        But in '96 when pain became a sense and, in my opinion, we
    let the genie out of the bottle. We started treating it like it
    was something that can be treated like a cold or the flu, and
    all we do is mask it.
        And we've seen stronger and stronger drugs coming out.
    We've seen them become controlled substance--narcotics--that we
    send home simply in a bottle with a prescription and say that
    is--that is controlled.
        Now we've seen an epidemic spread from the middle class to
    the low class to the wealthy and to our mothers and our
    fathers, to our brothers and our sisters and our coworkers.
        When do we put the genie back in the bottle? How do we
    continue to allow drugs--addictive drugs--continue to be sent
    home with our loved ones? The highest percentage of death--of
    accidental opioid deaths--are mothers--middle-age women. Most
    of them got addicted to them after birth or an elective
    surgery.
        How is that possible? How do we let it continue to move
    down that path and not say that we have to do something bold
    about this? When it's a controlled substance, why do we allow
    it to go home? Wouldn't that be better treated in the hospital?
        We talk about a lot of remedies but we have got to go back
    to where it started, and it started when we started treating it
    like a sense.
        I am very proud to be on this subcommittee. I am very proud
    that, Chairman Burgess, you are taking a very heavy interest in
    this and I am proud that Chairman Murphy had took an interest
    in this, too.
        And that is why we are proud to be able to pick up one of
    his bills. It is H.R. 3545 that will at least allow doctors
    after surgery to be able to access records to know if that
    person has an addictive behavior so we are not sending those
    type of drugs home with them.
        I look forward to continuing to work with the committee. I
    look forward to finally being able to put some type of remedy
    in bringing this to a closure and quit hurting our families
    back home, and I hope that we can approach this in a bipartisan
    approach, put politics aside, and put families first.
        Thank you. I look forward to working with you. I yield
    back.
        [The prepared statement of Mr. Mullin follows:]

                  Prepared statement of Hon. Markwayne Mullin

        It's so common to hear from the media about the dysfunction
    of Washington. It's so uncommon to hear the success stories. As
    a member of the Energy and Commerce Committee, I've been
    working on legislation related to opioid abuse since March of
    2015, when our committee led a number of bipartisan initiatives
    to help address the opioid epidemic. That year, we were
    successful in passing numerous pieces of legislation through
    committee and through the House.
        In July of 2016, President Obama signed the Comprehensive
    Addiction and Recovery Act, or CARA, into law--which included
    over a dozen bills passed by the Energy and Commerce Committee.
    Our committee is a productive one and the legislation passed
    helps fight the opioid epidemic from the ground up.
        The Comprehensive Addiction and Recover Act (CARA) and the
    21st Century Cures Act offered a truly comprehensive response
    to the opioid epidemic and touches on prevention, criminal
    justice reform, access to treatment, overdose reversal, and
    recovery. The final bill included an amendment that I offered,
    which ensures that the Attorney General considers the needs of
    Native Americans, rural communities, and communities heavily
    impacted by opioid overdose deaths when awarding grants.
        Overprescribing painkillers has been a significant driver
    in the opioid and heroin epidemic, which is why CARA and CURES
    created a task force to review best practices for chronic and
    acute pain management and prescribing pain medication. It
    improved access to the overdose treatment and the opioid
    reversal drug naloxone and it expanded NIH opioid research.
        Just last week in my district, the Claremore Police
    Department used the opioid reversal drug, Narcan, for the first
    time in the field. The victim, who was found unconscious and
    admitted to using opioids, was taken to the hospital for
    further treatment after police were able to administer the
    Narcan drug. These success stories are taking place nationwide,
    thanks to CARA and CURES. I am very proud to have worked on
    CARA and CURES, but there is still more work that needs to be
    done.
        Oklahoma has been hit hard by the epidemic. Our Attorney
    General has filed a suit against opioid manufacturers, Cherokee
    Nation has filed a suit against drug distributors and
    pharmacies, and our Governor has assembled an Oklahoma
    Commission on Opioid Abuse. In 2014, Oklahoma had the 10th-
    highest drug overdose death rate in the Nation. More people
    died from overdoses than in car crashes. My district also has
    two of the five counties in the entire State that have the
    highest rates of unintentional painkiller overdoses--Coal and
    Muskogee.
        We can all agree that more needs to be done to address this
    crisis, which is why I have worked with my colleague Rep.
    Katherine Clark to introduced H.R. 3528, the Every Prescription
    Conveyed Securely (EPCS) Act. The EPCS Act would direct all
    States to employ electronic prescribing for controlled
    substances (EPCS) technology for Medicare Part D transactions
    by 2020. This is a step that seven States have already taken in
    an effort to combat the crisis and better secure the
    prescription distribution chain. So far all of our policy has
    been reactive, and this policy is proactive.
        This policy prevents large amounts of opiates from ever
    reaching the addicts hands and dramatically decreases doctor
    shopping. The EPCS Act will provide real-time reporting and
    ensure that the information gathered by electronic medical
    records can be used in a meaningful way. Electronic prescribing
    solutions, currently provided by more than 20 companies, are
    used like an app on the Electronic Health Records and give
    prescribers feedback on when prescriptions are filled and with
    what drug.
        According to the Department of Justice, most illegally
    obtained prescription opioids are obtained either through
    doctor shopping, forged prescriptions, and theft, which can be
    addressed by an EPCS regime. Another piece of legislation I am
    supportive of is H.R. 3545, the Overdose Prevention and Patient
    Safety Act, also known in the Senate as Jessie's Law. This
    legislation would help put the laws governing the medical
    records of those struggling with addiction into the 21st
    Century.
        Currently, a law that was passed in 1972 still governs how
    doctors and health care professionals share alcohol or
    substance use disorder treatment records. Under this law, when
    a patient goes to receive treatment at an addiction treatment
    facility, their medical records will remain segregated from the
    patient's overall medical record. This puts the patient at
    tremendous risk because doctors can no longer know their
    patient's substance use or history of care. In the case of
    Jessie Grubb, this outdated law was fatal.
        Jessie, who was in substance use recovery, went in for
    routine surgery, and providers were informed by her parents
    that she should not be given opioids except under strict
    supervision. However, upon discharge Jessie was prescribed 50
    oxycodone pills, and the hospital pharmacy filled the
    prescription because her substance use disorder treatment
    history was not in her medical record. That night, she died as
    the result of an overdose. Doctors cannot safely treat their
    patients if they don't know the whole story. H.R. 3545 would
    prevent tragedies like Jessie's and bring the Part 2 law into
    the 21st century.
        Our committee has done good work to combat the opioid
    epidemic, but our work isn't done. We can do more. We can
    inspire more success stories, but our work starts here. I urge
    my colleagues today to support these two bills and continue our
    dedication on this committee to combating the deadly opioid
    epidemic. I yield back the remainder of my time.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Chair recognizes the gentleman from New York, Mr. Tonko,
    for 3 minutes.

    STATEMENT OF HON. PAUL TONKO, A REPRESENTATIVE IN CONGRESS FROM
                         THE STATE OF NEW YORK

        Mr. Tonko. Thank you, Chair Burgess and Ranking Member
    Green, and members of the subcommittee.
        We are a nation in crisis. The opioid epidemic is wreaking
    havoc in our communities at an unprecedented scale with CDC
    estimating 64,000 dead from drug overdoses in 2016--an
    astonishing 21 percent increase from the previous year.
        This public health disaster is costing us more lives
    annually than at the peak of the AIDS epidemic--as many lives
    as gun violence and traffic accidents combined.
        If this Congress doesn't find additional solutions to turn
    the tide on the opioid epidemic, we will be complicity in this
    American tragedy.
        I am here today to offer two such legislative solutions.
    First, I introduced the Addiction Treatment Access Improvement
    Act--H.R. 3692--with my good friend, Congressman Ben Ray Lujan.
        This legislation would expand access to medication-assisted
    treatment by allowing certified nurse midwives and other
    advanced practice registered nurses to prescribe buprenorphine
    and, in addition, this legislation would codify the 2016 rule
    that allowed physicians to treat up to 275 patients with
    buprenorphine and eliminate the sunset of a provision that
    allows nonphysician providers to prescribe MAT.
        The Addiction Treatment Access Improvement Act would
    particularly benefit pregnant and post-partum women who are
    struggling with addiction and improve outcomes for the over
    13,000 infants that are born each year with neonatal abstinence
    syndrome.
        Despite the expansion of medication-assisted treatment in
    the Comprehensive Addiction and Recovery Act, there is still a
    significant shortage in treatment capacity, resulting in
    individuals waiting months, if not years, to receive effective
    addiction treatment. Only 20 percent of patients who need
    treatment for opioid use disorder are currently receiving it.
        Let me repeat that. Only 20 percent of patients who need
    treatment for opioid use disorder are currently receiving it.
    The Addiction Treatment Access Improvement Act would address
    this treatment gap and save lives.
        This committee should act on this bipartisan legislation
    without delay.
        The second bill I'd like to discuss is the Medicaid Reentry
    Act--H.R. 4005. This legislation is a targeted attempt to
    address the problem of overdose deaths that occur post-
    incarceration.
        Studies have shown that individuals who are released back
    into the community post-incarceration are, roughly, eight times
    more likely to die of an overdose in the first two weeks post-
    release compared to other times.
        The risk of overdose is elevated during this period due to
    reduced physiological tolerance for opioids amongst the
    incarcerated population, a lack of effective addiction
    treatment options while incarcerated, and poor care transitions
    back into the community.
        The Medicaid Reentry Act would grant States flexibility to
    restart Medicaid coverage for Medicaid-eligible individuals 30
    days pre-release.
        By allowing the Medicaid benefit to restart prior to
    release, States would be able to more readily provide effective
    addiction treatment pre-release and would allow for smoother
    transitions to community care, reducing the risk of overdose
    deaths post-release, striking an overall wiser use of scarce
    Medicaid dollars.
        Let me be clear: This legislation that I've introduced
    would not expand Medicaid eligibility in any way. It would
    simply grant States new flexibility to restart an individual's
    Medicaid benefits 30 days earlier than allowed under current
    law.
        This increased flexibility would dovetail with innovative
    reentry programs already being championed by Republicans and
    Democrats in States across our country and would give
    individuals reentering society a fighting chance to live a
    healthier drug-free life.
        Let me just end with an urgent plea for action and
    bipartisanship. I know that many of the ideas that this
    committee will hear today would, in normal times, be met with
    the typical partisan objections and end up stuck in a
    procedural morass.
        These are not normal times. When your house is on fire you
    don't look to see whether the firefighter is wearing red or
    blue uniforms before they turn their hoses on.
        If we are truly going to make a difference in this crisis
    and save lives, we have to have a big heart and an open mind.
        I thank my colleagues for their time and for their
    consideration of this legislation that I have presented and,
    again, to the chair, ranking member, and members of the
    subcommittee, thank you for offering such, you know, attention
    to a crisis that has gripped this country in severe measure.
        Thank you. I yield back.
        [The prepared statement of Mr. Tonko follows:]

                     Prepared statement of Hon. Paul Tonko

        Thank you, Mr. Chairman.
        We are a nation in crisis. The opioid epidemic is wreaking
    havoc in our communities at an unprecedented scale, with the
    CDC estimating 64,000 dead from drug overdoses in 2016, an
    astonishing 21 percent increase from the previous year.
        This public health disaster is costing us more lives
    annually than at the peak of the AIDS epidemic--as many lives
    as gun violence and traffic accidents combined.
        If this Congress doesn't find additional solutions to turn
    the tide on the opioid epidemic, we will be complicit in this
    American tragedy.
        I'm here today to offer two such legislative solutions.
        First, I introduced the Addiction Treatment Access
    Improvement Act, H.R. 3692, with my good friend Congressman Ben
    Ray Lujan. This legislation would expand access to medication-
    assisted treatment by allowing certified nurse midwives and
    other advanced practice registered nurses to prescribe
    buprenorphine. In addition, this legislation would codify the
    2016 rule that allowed physicians to treat up to 275 patients
    with buprenorphine and eliminate the sunset of a provision that
    allows nonphysician providers to prescribe MAT.
        The Addiction Treatment Access Improvement Act would
    particularly benefit pregnant and postpartum women who are
    struggling with addiction and improve outcomes for the over
    13,000 infants that are born each year with neonatal abstinence
    syndrome.
        Despite the expansion of medication-assisted treatment in
    Comprehensive Addiction and Recovery Act, there is still a
    significant shortage in treatment capacity, resulting in
    individuals waiting months or years to receive effective
    addiction treatment. Only 20 percent of patients who need
    treatment for opioid use disorder are currently receive it.
        The Addiction Treatment Access Improvement Act would
    address this treatment gap and save lives. This committee
    should act on this bipartisan legislation without delay.
        The second bill I'd like to discuss is the Medicaid Reentry
    Act, which is a targeted attempt to address the problem of
    overdose deaths that occur post-incarceration.
        Studies have shown that individuals who are released back
    into the community post-incarceration are roughly 8 times more
    likely to die of an overdose in the first two weeks post-
    release compared to other times. The risk of overdose is
    elevated during this period due to reduced physiological
    tolerance for opioids among the incarcerated population, a lack
    of effective addiction treatment options while incarcerated and
    poor care transitions back into the community.
        The Medicaid Reentry Act would grant States flexibility to
    restart Medicaid coverage for Medicaid-eligible individuals 30-
    days pre-release. By allowing Medicaid benefits to restart
    prior to release, States would be able to more readily provide
    effective addiction treatment pre-release and would allow for
    smoother transitions to community care, reducing the risk of
    overdose deaths post-release.
        This legislation would not expand Medicaid eligibility in
    any way, it would simply grant States new flexibility to
    restart an individual's Medicaid benefits 30-days earlier than
    allowed under current law. This increased flexibility would
    dovetail with innovative reentry programs already being
    championed by Republicans and Democrats in States across the
    country and would give individuals reentering society a
    fighting chance to live a healthier, drug-free life.
        Let me just end with an urgent plea for action and
    bipartisanship. I know that many of the ideas that this
    committee will hear today would, in normal times, be met with
    the typical partisan objections and end up stuck in a
    procedural morass.
        These are not normal times. When your house is on fire, you
    don't look to see whether the firemen are wearing red or blue
    uniforms before they turn the hoses on.
        If we are truly going to make a difference in this crisis
    and save lives we have to have a big heart and an open mind.
        I thank my colleagues for their time and for their
    consideration of the legislation I have presented.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        Chair recognizes the gentleman from North Carolina, Mr.
    Hudson, for 3 minutes, please.

    STATEMENT OF HON. RICHARD HUDSON, A REPRESENTATIVE IN CONGRESS
                    FROM THE STATE OF NORTH CAROLINA

        Mr. Hudson. Thank you, Chairman Burgess and Ranking Member
    Green, for giving me the opportunity to speak on behalf of my
    constituents.
        As has been noted, the opioid epidemic is not an isolated
    issue. It is a nationwide issue and it deserves our attention.
    The New York Times noted last month that the opioid epidemic is
    killing more people per year right now than the HIV epidemic
    did at its peak in the '90s.
        These drugs do not discriminate based on gender, race,
    social class, or age, and they destroy lives, families,
    marriages, and careers.
        In my home State of North Carolina, the opioid epidemic has
    really hit hard. North Carolina is home to four cities in the
    top 25 of worst cities affected by the crisis, one of which is
    in my district, Fayetteville, North Carolina.
        One particularly devastating story that stuck with me from
    a constituent I met while touring a treatment facility last
    year in my district, he was a police captain, the son of the
    police chief in the same town, and he injured his back on the
    job and was prescribed an opioid following his surgery.
        He told me he vividly remembers the moment he became
    addicted the first time he took one of these medications.
    Within a year, he was a full-blown heroin addict. He's since
    recovered and now mentors addicts through treatment.
        Unlike many stories, this is a story with a happy ending.
    Fayetteville has become home to soldiers and veterans--or is
    the home of soldiers and veterans who have become addicted
    after being prescribed opioids for injuries sustained in combat
    or training.
        The tragedy is that the VA does not have enough inpatient
    beds to treat every veteran and so oftentimes veterans go
    without help and are forced to self-medicate by using opioids
    found on the black market.
        This is outrageous and it is unacceptable. We need to find
    real solutions so we can put an end to this heartbreak.
        I am proud to have worked last Congress with this
    committee's investigation into opioid addiction which resulted
    in the passage of both the Comprehensive Addiction and Recovery
    Act and the 21st Century Cures Act.
        These laws have made huge steps forward in the treatment
    and prevention of opioid addiction but it is clear we have work
    left to do.
        One idea I am working on is expanding access to safe ways
    to dispose of prescription drugs, particularly opioids.
    DisposeRX is a company in my district that manufacturers a
    powder that mixes with water inside the pill bottle and renders
    any unused opioids not only inaccessible and inextricable but
    also biodegradable.
        It is innovation ideas like this that we need to explore
    and I look forward to working with my colleagues on the
    committee to help treat and prevent this opioid addiction.
        Thank you, Mr. Chairman. I yield back.
        [The prepared statement of Mr. Hudson follows:]

                   Prepared statement of Hon. Richard Hudson

        Thank you, Chairman Walden and Chairman Burgess, for giving
    me the opportunity to speak on behalf of my constituents. As
    has been noted, the opioid epidemic is not an isolated issue.
    It is a nationwide issue and it deserves our attention. The New
    York Times noted last month that the opioid epidemic is killing
    more people per year right now than the HIV epidemic did at its
    peak in the nineties. These drugs do not discriminate based on
    gender, race, social class, or age and they destroy lives,
    families, marriages, and careers.
        In my home State of North Carolina, the opioid epidemic has
    really hit hard. North Carolina is home to four cities in the
    top 25 of worst cities affected by this crisis, one of which is
    in my district, Fayetteville. One particularly devastating
    story that has stuck with me was from a constituent I met while
    touring a treatment facility in my district. He was a police
    captain--the son of a police chief in the same town--and
    injured his back on the job and was prescribed an opioid
    following surgery. He told me he vividly remembers becoming
    addicted the first time he took one of these medications.
    Within a year, he was a full blown heroin addict. He's since
    recovered and now mentors addicts going through treatment, but
    his story has an unusually happy ending.
        Fayetteville is also home to soldiers and veterans who have
    become addicted after being prescribed opioids for injuries
    sustained in combat or training. One problem with this epidemic
    is the VA does not have enough inpatient beds to treat every
    veteran so oftentimes veterans go without help and are forced
    to self-medicate by using opioids acquired on the black market.
    We need to find real solutions so we can put an end to this
    heartbreak.
        I am proud to have worked last Congress on this committee's
    investigation into the opioid addiction which resulted in the
    passage of both the Comprehensive Addiction and Recovery Act
    and the 21st Century Cures act. These laws have made huge steps
    forward in the treatment and prevention of opioid addiction,
    but it is clear we have work left to do. One idea I am working
    on is expanding access to safe ways to dispose of prescription
    drugs, particularly opioids. DisposeRx, a company in my
    district, manufactures a powder that mixes with water inside
    the pill bottle and renders any unused opioids not only
    inaccessible and inextricable, but also bio-degradable. It is
    innovative ideas like this that we need to explore and I look
    forward to working with colleagues on committee to help treat
    and prevent opioid addiction.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        Chair recognizes the gentleman from Massachusetts, Mr.
    Kennedy, for 3 minutes, please.

     STATEMENT OF HON. JOSEPH P. KENNEDY, III, A REPRESENTATIVE IN
            CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS

        Mr. Kennedy. Thank you, Mr. Chairman, and many thanks to
    the ranking member, Mr. Green, as well for convening this
    hearing and for bringing all of us together--our colleagues
    from across the country.
        I also want to thank my colleagues that have testified
    already. Their comments, I think, are right on. I think they
    show the depth of this epidemic across the country and how it's
    affected so many in our districts from around our Nation and
    the myriad ways in which our Federal Government can help
    respond to it.
        There is no silver bullet to this but there are ideas out
    there that are, I think, genuine that have widespread support
    and that I hope will deserve this committee's attention, going
    forward.
        Addiction, as many know, is not a disease that knows
    congressional districts or State borders or electoral college
    results. It is not one that cares about how much money is in
    your bank account or asks how many children you have.
        For patients and families on the front lines of this
    epidemic today it is personal, it is painful, and it is
    petrifying.
        The question, I think, before all of us isn't is there an
    epidemic. I think you've heard from everybody today saying that
    there is.
        The question is how do we go forward. My colleagues have
    outlined some of their solutions. I wanted to touch on a couple
    of broad themes as well.
        First and foremost is Medicaid. Medicaid, as of now, covers
    about 30 percent of all nonelderly adults with an opioid
    addiction in this country--30 percent--and the 20 percent of
    opioid addicts that do not have health insurance largely stems
    from individuals in States that did not take a Medicaid
    expansion.
        This is not enough. We need to strengthen our Medicaid
    programs to ensure that everybody gets the care that they need
    when they need it.
        That means not just ensuring access to Medicaid and
    eligibility but it means fleshing out the networks that
    Medicaid provides so that you don't have the stories that so
    many of us have heard from folks around the country of even if
    they are enrolled in Medicaid that there are not providers that
    will take it, and if providers do take it that they would have
    wait months in order to get a slot to get into treatment.
        There is complex reasons for that but, in my own opinion, a
    big portion of that comes through low Medicaid reimbursement
    rates that ends up putting the burden of treatment on the backs
    of providers rather than making sure that patients get the care
    that they need.
        Second is law enforcement. Folks, we lock people up in this
    country that are sick and we need to be doing an awful lot more
    not only to make sure that that safety net for our mental
    health system is not a criminal justice system but supporting
    our first responders and police officers who end up being on
    the front lines of this epidemic and addiction epidemic across
    the country and put in an impossible place of forcing to have
    to arrest people, forcing to put themselves in danger because
    our mental health system is not robust enough.
        I was a State prosecutor. We threw people in jail that were
    sick. They would break into homes and cars to try to satiate an
    opioid epidemic--an opioid addiction because they didn't have
    anywhere else to go.
        Finally--and I will be brief, Mr. Chairman--the medical
    community. You heard Mrs. Brooks talk about education. We have
    heard folks talk about prediction of drug monitoring programs.
    We have heard folks talk about prescription guidelines. All of
    those need to be on the table.
        I, like Mr. Mullin, have had surgery before. I got in an
    argument with a surgery technician on my hospital bed who was
    trying to prescribe me pain killers that I wouldn't take
    because I am so deathly afraid of these things. That part needs
    to change.
        I look forward to working with my colleagues in the weeks
    and months ahead to try to make sure that our Government does
    take the step forward we need.
        I yield back.
        Mr. Burgess. Chair thanks the gentleman.
        Chair thanks everyone on this panel. We will allow you to
    depart, and we have a panel that will be Mr. Costello of
    Pennsylvania, Mr. Walberg of Michigan, Mr. Carter of Georgia,
    and Chairman Goodlatte of Virginia.
        And Mr. Walberg, we are doing Energy and Commerce members
    first. But with your permission, I will go to the Chairman of
    the Judiciary Committee since he has made time to be with us
    this morning.
        And Chairman Goodlatte, you are recognized for 3 minutes.

     STATEMENT OF HON. BOB GOODLATTE, A REPRESENTATIVE IN CONGRESS
                   FROM THE COMMONWEALTH OF VIRGINIA

        Mr. Goodlatte. Mr. Chairman, Ranking Member Green, members
    of the committee, thank you very much for the opportunity to
    testify about the opioid crisis in America.
        This crisis affects Americans across all socioeconomic
    levels in all regions of the country, including in my home
    district in Virginia, and has rightfully gained the attention
    of Congress.
        According to the Northern Shenandoah Valley Substance Abuse
    Coalition, they have seen 11 opioid overdoses resulting in four
    deaths since September 20th, making 33 deaths in that portion
    of my district so far this year.
        Just recently, I met with a mother in Roanoke whose
    daughter is an opioid addict living on the streets. Her concern
    for her daughter was heartbreaking to hear.
        Sadly, I know that every Member of Congress in this room
    has heard these stories of bright futures wasted away and lives
    taken too early.
        That is why we must act to provide more tools to help
    addicts reclaim and rebuild their lives, stop drug traffickers,
    and make our communities safer.
        We at the Judiciary Committee have been pleased to work
    with the committee on Energy and Commerce in this fight to
    combat this epidemic.
        Since last year, the Judiciary Committee has passed seven
    legislative measures that address the multifaceted nature of
    the opioid epidemic.
        Notably, the Judiciary and Energy and Commerce Committees
    worked collaboratively to see the Comprehensive Opioid Abuse
    Reduction Act--CARA--signed into law last year.
        This bipartisan legislation combats the opioid epidemic by
    establishing a streamlined comprehensive opioid abuse grant
    program including vital training and resources for first
    responders and law enforcement, criminal investigations for the
    unlawful distribution of opioids, drug and other alternative
    treatment courts, and residential substance abuse treatment.
        We have also targeted those who traffic in opioids. The
    Transnational Drug Trafficking Act, which is now law, improves
    law enforcement's ability to pursue international drug
    manufacturers, brokers, and distributors in source nations.
        Federal prosecutors can now use the important tools in that
    bill to pursue foreign drug traffickers who are poisoning
    American citizens.
        Additionally, in July of this year, the Judiciary Committee
    reported favorably the Stop the Importation and Trafficking of
    Synthetic Analogs Act. It is an unfortunate reality that
    synthetic drug use and the opioid epidemic are inextricably
    linked. Heroin is regularly laced with synthetic drugs such as
    fentanyl.
        This bill ensures that our laws keep pace with the creation
    of new chemically altered drugs and provides law enforcement
    with the tools needed to keep these drugs off of our streets.
        That legislation, I believe, is currently before the Energy
    and Commerce Committee. I hope you will take a very close look
    at it and if we can pass it out of the committee I am sure it
    will pass the House with a very strong vote.
        Mr. Chairman and members of the committee, I appreciate the
    opportunity to testify. My dedication to curtailing the opioid
    crisis is unwavering and I look forward to our continued work
    together to that end.
        Thank you.
        [The prepared statement of Mr. Goodlatte follows:]

                    Prepared statement of Hon. Bob Goodlatte

        Chairman Walden and Ranking Member Pallone, thank you for
    the opportunity to testify about the opioid crisis in America.
    This crisis affects Americans across all socioeconomic levels
    in all regions of the country--including in my home district in
    Virginia--and has rightfully gained the attention of Congress.
        According to the Northern Shenandoah Valley Substance Abuse
    Coalition, they have seen 11 opioid overdoses resulting in four
    deaths since September 20th--making 33 deaths in that region so
    far this year. Just recently, I met with a mother in Roanoke
    whose daughter is an opioid addict living on the streets. Her
    concern for her daughter was heartbreaking to hear.
        Sadly, I know that every Member of Congress in this room
    has heard these stories of bright futures wasted away and lives
    taken too early. That is why we must act to provide more tools
    to help addicts reclaim and rebuild their lives, stop drug
    traffickers, and make our communities safer.
        The Committee on Energy and Commerce, as well as the House
    Judiciary Committee, of which I currently serve as chair, has
    been active in the fight to combat this epidemic. Since last
    year, the Judiciary Committee has passed seven legislative
    measures that address the multifaceted nature of the opioid
    epidemic.
        Notably, the Judiciary and Energy and Commerce Committees
    worked collaboratively to see the Comprehensive Opioid Abuse
    Reduction Act signed into law last year. This bipartisan
    legislation combats the opioid epidemic by establishing a
    streamlined, comprehensive opioid abuse grant program,
    including vital training and resources for first responders and
    law enforcement, criminal investigations for the unlawful
    distribution of opioids, drug and other alternative treatment
    courts, and residential substance abuse treatment.
        We have also targeted those who traffic in opioids. The
    Transnational Drug Trafficking Act, which is now law, improves
    law enforcement's ability to pursue international drug
    manufacturers, brokers, and distributors in ``source nations.''
    Federal prosecutors can now use the important tools in that
    bill to pursue foreign drug traffickers who are poisoning
    American citizens.
        Additionally, in July the Judiciary Committee reported
    favorably the Stop the Importation and Trafficking of Synthetic
    Analogues Act. It is an unfortunate reality that synthetic drug
    use and the opioid epidemic are inextricably linked. Heroin is
    regularly laced with synthetic drugs, such as fentanyl. This
    bill ensures that our laws keep pace with the creation of new,
    chemically altered drugs and provides law enforcement with the
    tools needed to keep these drugs off of our streets.
        Mr. Chairman and members of the committee, I appreciate the
    opportunity to testify. My dedication to curtailing the opioid
    crisis is unwavering. I look forward to our continued work
    together to that end.

        Mr. Burgess. The Chair thanks the gentleman. Thanks for
    making time to be with us on our panel today. We sincerely
    appreciate you being here. We know we have got work to do, and
    we will work together on this.
        Mr. Goodlatte. Thanks for the opportunity.
        Mr. Burgess. Mr. Walberg, you are recognized for 3 minutes,
    please.

      STATEMENT OF HON. TIM WALBERG, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF MICHIGAN

        Mr. Walberg. Thank you, Mr. Chairman, and I am always
    delighted to go behind the chairman of the Judiciary Committee,
    especially since there are some of my bills in this committee.
        But let me say, Chairman Burgess and Ranking Member Green,
    I want to thank you for holding today's hearing to receive
    input from members who represent different corners of our
    country and yet the very same problem.
        Since the heroin and opioid crisis came to the forefront, I
    have heard so many devastating stories about families losing
    loved ones. I have toured recovery centers, talked with
    survivors who continue to battle addiction and ridden along
    with law enforcement to understand the challenges that they
    face in keeping our neighbourhoods safe.
        I have also met a number of amazing compassionate
    individuals--fellow citizens who have stepped up and are
    leading the fight in their communities.
        A few weeks ago, I had the opportunity to meet with a
    constituent named George Barath from Monroe County. He
    established Ryan's Hope Foundation, a nonprofit organization
    named in honor of his son who died from a heroin overdose in
    2012.
        He was only 25. Ryan's Hope funds structured long-term
    residential treatment for addicts and so far they have helped
    nearly--helped nearly 40 addicts by sending them to rehab.
        To help cover these costs, Mr. Barath has also teamed up
    with local first responders to organize a charity hockey game
    called Hockey Against Heroin.
        In Lenawee County, my own home county, the Pathways
    Recovery Engagement Center just opened its doors last week. I
    got a chance to see the center in August when it was in the
    final stages of construction.
        This recovery-based program in downtown Adrian is the
    result of a community partnership between local police and the
    county sheriff's office, Rotary Clubs, and the local hospital
    system and mental health authority.
        Ryan's Hope and the Pathways Resource Center are just two
    shining examples of constituents in my district making a
    difference. We need more community-based initiatives like these
    to get resources to those in need.
        But Congress also has more to do. One example is Jessie's
    Law, a bipartisan bill I have introduced with Congresswoman
    Debbie Dingell. It seeks to ensure that medical professionals
    are equipped to safely treat their patients and prevent
    overdose tragedies.
        It is named after Jessie Grubb, who died last year of an
    opioid overdose. Jessie had battled a heroin addiction for
    nearly 7 years but had been clean for six months. She had made
    a new life for herself in Michigan and was training for a
    marathon when an infection related to a running injury required
    her to have surgery.
        Jessie's parents told doctors that she was a recovering
    addict and shouldn't be prescribed opioids. Unfortunately,
    Jessie's discharging physician didn't know her addiction
    history and sent Jessie home with a prescription for 50
    oxycodone pills. Jessie became a sad death by overdose
    statistic.
        Jessie's law will ensure that physicians and nurses have
    access to a consenting patient's complete health information
    when making treatment decisions.
        Such information is crucial to provide a patient-centered
    care, prevent relapses, and ultimately save lives. As we work
    together to address this crisis, it is my hope the stories and
    ideas shared today will inform our efforts and ensure we pursue
    meaningful solutions to remove obstacles to care and empower
    local communities to tackle the opioid crisis head on, and I
    thank you for listening to my story.
        [The prepared statement of Mr. Walberg follows:]

                     Prepared statement of Hon. Tim Walberg

        Chairman Burgess, Ranking Member Green, I want to thank you
    for holding today's hearing to receive input from Members who
    represent different corners of our country.
        Since the heroin and opioid crisis came to the forefront, I
    have heard so many devastating stories about families losing
    loved ones. I've toured recovery centers, talked with survivors
    who continue to battle addiction, and ridden along with law
    enforcement to understand the challenges they face in keeping
    our neighborhoods safe. I've also met a number of individuals
    who have stepped up and are leading the fight in their
    communities.
        A few weeks ago, I had the opportunity to meet with a
    constituent named George Barath from Monroe County. He
    established Ryan's Hope Foundation, a nonprofit organization
    named in honor of his son who died from a heroin overdose in
    2012. He was only 25. Ryan's Hope funds a structured, long-term
    residential treatment for addicts, and so far they have helped
    send nearly 40 addicts to rehab. To help cover these costs, Mr.
    Barath has also teamed up with local first responders to
    organize a charity hockey game called ``Hockey Against
    Heroin.''
        In Lenawee County, the Pathways Recovery Engagement Center
    just opened its doors last week. I got a chance to see the
    center in August when it was in the final stages of
    construction. This recovery-based program in downtown Adrian is
    the result of a community partnership between local police and
    the county sheriff's office, rotary, and the local hospital
    system and mental health authority.
        Ryan's Hope and the Pathways Recover Center are just two
    shining examples of constituents in my district making a
    difference. We need more community-based initiatives like these
    to get resources to those in need, but Congress also has more
    to do.
        One example is a Jessie's Law, a bipartisan bill I
    introduced with Congresswoman Debbie Dingell. It seeks to
    ensure that medical professionals are equipped to safely treat
    their patients and prevent overdose tragedies.
        It's named after Jessie Grubb, who died last year of an
    opioid overdose. Jessie had battled a heroin addiction for
    nearly 7 years but had been clean for six months. She had made
    a new life for herself in Michigan and was training for a
    marathon when an infection related to a running injury required
    her to have surgery.
        Jessie's parents told doctors that she was a recovering
    addict and shouldn't be prescribed opioids. Unfortunately,
    Jessie's discharging physician didn't know her addiction
    history and sent Jessie home with a prescription for 50
    oxycodone pills.
        Jessie's Law will ensure that physicians and nurses have
    access to a consenting patient's complete health information
    when making treatment decisions. Such information is crucial to
    provide patient-centered care, prevent relapses and ultimately,
    save lives.
        As we work together to address this crisis, it is my hope
    the stories and ideas shared today will inform our efforts and
    ensure we pursue meaningful solutions that remove obstacles to
    care and empower local communities to tackle the opioid crisis
    head on.

        Mr. Burgess. Gentleman yields back. The Chair thanks the
    gentleman, and I believe this concludes all the Energy and
    Commerce members seeking to give testimony. If any arrive, we
    will allow them to testify as they come in.
        But I think our panel now will be Chairman Rogers, Mr.
    Marshall of Kansas, Mr. Turner, mayor of Dayton, Ohio.
        Mrs. Bustos, if you wish to join us now, that would be good
    as well. And Chairman Rogers, thank you for being here and
    being part of this discussion this morning. You are recognized,
    sir.

     STATEMENT OF HON. HAROLD ROGERS, A REPRESENTATIVE IN CONGRESS
                   FROM THE COMMONWEALTH OF KENTUCKY

        Mr. Rogers. Well, thank you, Mr. Chairman, and colleagues.
    Thank you for hosting us on this very, very important topic.
        Over the past 15 years, many of you have heard me advocate
    for a holistic approach to the calamity that we face, including
    enforcement, prevention, and treatment measures like those
    successfully implemented by Operation Unite in Kentucky.
        We need to further encourage regional collaboration on this
    issue that ignores lines on a map, and I hope to work with the
    committee on this issue in the future.
        Today, however, Mr. Chairman, I would like to focus on
    treatment. Despite the light we've shown on addiction, only 10
    percent of those needing treatment for alcohol or drug-related
    addiction actually receive it--10 percent.
        Underlying challenges in the treatment workforce further
    compound this lack of access. There are simply not enough
    incentives for health professionals in training to specialize
    in addiction medicine.
        Treatment professionals work in stressful environments,
    receive relatively low pay, and turn over at rates much higher
    than other health professionals.
        NIH continually pioneers research on addiction science and
    new ways to treat this chronic disease. Yet, America has only
    half the number of practising addiction specialists needed to
    put their findings in practice.
        This is a patient safety and public health calamity.
    Patients in need of addiction treatment often have access to
    specialized care in every corner of the country.
        That is why I will soon be introducing legislation with my
    colleague, Katherine Clark, to create a student loan repayment
    program for qualified substance use disorder treatment
    professionals.
        This program will not only encourage health professionals
    to pursue careers in addiction medicine but steer them towards
    areas most in need of their services.
        Though it is not a silver bullet, this bill would be
    another substantial step in the right direction and I hope to
    work with each of you, Mr. Chairman and members, to this end
    and I thank you for allowing us here today.
        I yield.
        [The prepared statement of Mr. Rogers follows:]

                    Prepared statement of Hon. Harold Rogers

        Thank you, Mr. Chairman. I appreciate you holding this
    hearing to discuss Congress' continued work on opioid misuse
    and abuse. Over the past 15 years, many of you have heard me
    advocate for a holistic approach to addiction, including
    enforcement, prevention, and treatment measures like those
    successfully implemented by Operation UNITE in Kentucky. We
    need to further encourage regional collaboration on this issue
    that ignores lines on a map. I hope to work with the committee
    on this issue in the future.
        Today, however, I'd like to focus on treatment. Despite the
    light we've shone on addiction, only 10 percent of those
    needing treatment for alcohol- or drug-related addiction
    actually receive it. Underlying challenges in the treatment
    workforce further compound this lack of access.
        There are simply not enough incentives for health
    professionals in training to specialize in addiction medicine.
    Treatment professionals work in stressful environments, receive
    relatively low pay, and turnover at rates much higher than
    other health professionals. NIH continually pioneers research
    on addiction science and new ways to treat this chronic
    disease, yet America has only half the number of practicing
    addiction specialists needed to put their findings in practice.
        This is a patient safety and public health calamity.
    Patients in need of addiction treatment ought to have access to
    specialized care in every corner of this country. That is why I
    will soon be introducing legislation with my colleague
    Katherine Clark to create a student loan repayment program for
    qualified substance use disorder treatment professionals. This
    program will not only encourage health professionals to pursue
    careers in addiction medicine, but steer them towards areas
    most in need of their services.
        Though it's not a silver bullet, this bill would be another
    substantial step in the right direction. I hope to work with
    each of you to this end and I thank the chairman for having me
    today.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Will the gentleman from Georgia, an Energy and Commerce
    member, wish to join us at the table and, Mr. Carter, if you
    are ready I will recognize you for 3 minutes.

    STATEMENT OF HON. EARL L. ``BUDDY'' CARTER, A REPRESENTATIVE IN
                   CONGRESS FROM THE STATE OF GEORGIA

        Mr. Carter. Thank you, Mr. Chairman and Ranking Member
    Green.
        I want to start my testimony by thanking you for holding
    today's hearing for soliciting input from Members on how to
    continue to combat this growing epidemic.
        As a pharmacist, I have always made it a priority to advise
    and assist my patients with the medications they are
    prescribed. As a community pharmacist, I develop close bonds
    with people who are often my friends and neighbors. That bond
    pushes pharmacists to always act proactively in helping their
    patients.
        One of the largest concerns I have seen is the increased
    prescribing of opioids for pain relief. We need to look at
    other options and other outlets for the treatment of pain and
    find a good medium. I believe we can work with the FDA to
    prioritize nonopioid treatments for patients and create a
    channel for the approval of those therapies.
        In addition, as it currently stands, prescribers are able
    to write up to three 30-day prescriptions or Schedule II drugs
    for patients. I believe it would be pertinent to reexamine that
    prescribing structure and look at the effectiveness of allowing
    fewer initial prescriptions and a limited number of refills
    rather than three months of prescriptions.
        Similar to that notion, allowing pharmacists to have a
    greater say in limiting the number of pills filled in a
    prescription could help to address the transition to addiction.
        For instance, limiting the fill for acute pain needs such
    as a dental procedure could help prevent an individual from
    getting hooked on opioids.
        Under CARA, a pharmacist is only able to partially fill a
    prescription with the consent of the patient or prescriber or
    in the instance it doesn't have enough stock to fully fill a
    prescription.
        A simple seven-day fill could cover their pain needs and
    keep more pills out of potential use or circulation.
    Prescription drug monitoring programs--PDMPs--are a great
    resource in combatting prescription drug abuse. But they can be
    strengthened to better curb this epidemic.
        One way to do so is to better align the data including in
    those PDMPs so that States can collaborate to create a more
    comprehensive picture of people's drug use. Further linking
    State PDMPs and including data in work flows could allow for
    more accuracy in how States monitor and respond to potential
    abuses.
        Drug take-back programs continue to expand across the
    country. Currently, at least 19 States have some form of drug
    take-back programs and 23 States have programs allowing
    pharmacists to accept unused and unwanted drugs.
        One of the most common ways in which adolescents access
    prescription drugs is through the drug cabinets of their
    parents and grandparents.
        Too often these unused pills can act as a gateway to
    further abuse by young adults. Expanding these programs through
    law enforcement pharmacies or paid-for mail programs can take
    some of these prescription drugs off the street.
        The creation of middle grounds of therapies will provide
    for alternatives that are missing in today's market. By
    facilitating research and development, we can help drive the
    expensive and time-consuming efforts needed to make those
    treatments a reality.
        Currently, there are few options left between Tylenol,
    Tramadol, and opioids, and that void is driving prescription
    decisions across the country.
        So thank you, Mr. Chairman and committee, for the
    opportunity to provide testimony here today and I look forward
    to working with everyone to tackle this issue.
        [The prepared statement of Mr. Carter follows:]

              Prepared statement of Hon. Earl L. ``Buddy'' Carter

        Chairman Burgess and Ranking Member Green, I want to start
    my testimony by thanking you for holding today's hearing and
    for soliciting input from Members on how to continue to combat
    this growing epidemic.
        As a pharmacist, I have always made it a priority to advise
    and assist my patients with the medications they are
    prescribed. As a community pharmacist, I developed close bonds
    with people who were often my friends and neighbors. That bond
    pushes pharmacists to always act proactively in helping their
    patients.
        One of the largest concerns I have seen is the increased
    prescribing of opioids for pain relief. We need to look at
    other options and other outlets for the treatment of pain and
    find a good medium. I believe we can work with the FDA to
    prioritize nonopioid treatments for patients and create a
    channel for the approval of those therapies.
        In addition, as it currently stands, prescribers are able
    to write up to three 30-day prescriptions for schedule two
    drugs for patients. I believe it would be pertinent to
    reexamine that prescribing structure and look at the
    effectiveness of allowing fewer initial prescriptions and a
    limited number of refills rather than 3 months of
    prescriptions.
        Similar to that notion, allowing pharmacists to have a
    greater say in limiting the number of pills filled in a
    prescription could help to address the transition to addiction.
    For instance, limiting the fill for acute pain needs, such as a
    dental procedure, could help prevent an individual from getting
    hooked on opioids.
        Under CARA, a pharmacist is only able to partially fill a
    prescription with the consent of the patient or prescriber or
    in the instance it doesn't have enough stock to fully fill a
    prescription. A simple, seven-day fill could cover their pain
    needs and keep more pills out of potential use or circulation.
        Prescription drug monitoring programs (PDMPs) are a great
    resource in combating the prescription drug abuse, but they can
    be strengthened to better curb this epidemic. One way to do so
    is to better align the data included in those PDMPs so that
    States can collaborate to create a more comprehensive picture
    of people's drug use. Further linking State PDMPs and including
    data and work flows could allow for more accuracy in how States
    monitor and respond to potential abuses.
        Drug take-back programs continue to expand across the
    country. Currently, at least 19 States have some form of drug
    take back programs and 23 States have programs allowing
    pharmacies to accept unused and unwanted drugs. One of the most
    common ways in which adolescents access prescription drugs is
    through the drug cabinets of their parents and grandparents.
    Too often, these unused pills can act as a gateway to further
    abuse by young adults. Expanding these programs through law
    enforcement, pharmacies, or a paid-for mail programs can take
    some of these prescriptions drugs off the street.
        The creation of a middle ground of therapies will provide
    the alternatives that are missing in today's market. By
    facilitating research and development, we can help drive the
    expensive and time-consuming efforts needed to make those
    treatments a reality. Currently, there are few options left
    between Tylenol, Tramadol and opioids and that void is driving
    prescribing decisions across the country. We have an
    opportunity to support the efforts of NIH through public-
    private partnerships to address this and other issues.
        Finally, as a lifelong pharmacist, I am never short of
    amazed at how my colleagues in our profession continue to
    evolve and excel in their roles advising patients. We now have
    an opportunity to capitalize on existing progress and to work
    with the administration, the FDA, and outside groups to right
    the ship on opioid abuses. I thank the committee for the
    opportunity to provide testimony and I look forward to working
    with everyone to tackle this issue.

        Mr. Burgess. The Chair thanks the gentleman. The gentleman
    yields back.
        The Chair recognizes the gentlelady from Illinois, Mrs.
    Bustos, for 3 minutes, please.

     STATEMENT OF HON. CHERI BUSTOS, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF ILLINOIS

        Mrs. Bustos. All right. Thank you, Mr. Chairman, and also
    Ranking Member Green.
        I would like to start out by telling you a story about a
    young man from my congressional district in Rockford, Illinois.
    His name is Chris Boseman. I had the good fortune of meeting
    his mother, who told me this story.
        Chris passed away in the summer of 2014 when he was only 32
    years old. He had injured his back and as a result of that his
    physician prescribed an opioid to relieve his pain. Soon after
    that, he became dependent upon those--that prescription opioid
    and found out that he could go to the street and find something
    very cheap called heroin--$10.
        So he continued the cycle of overdose, rehab, relapse, and
    he was on the right path. He enrolled in a college called Rock
    Valley College, where he was studying construction management.
        But a year after being clean, he relapsed again and ended
    up passing away. And we know stories very similar to this are
    happening all over our country.
        And I was so proud when we came together, Democrats and
    Republicans, and actually passed some meaningful legislation
    on--to help address this opioid crisis.
        One of those bills that was included in that was to care
    for infants born with an opioid dependency due to their
    parents' addiction. In fact, we received the Government
    Accountability report that my bill called for very recently,
    and it reviews and makes recommendations to care for these
    infants.
        But what it really ended up showing is that we have a very
    long way to go. The Department of Health and Human Services has
    a strategy for improving infant care, but they haven't yet put
    this into practice.
        There is not even a protocol to screen and treat these
    newborn babies who are born addicted because of their parents'
    addiction. So it further reinforces that this is not the time
    to cut Medicaid.
        Medicaid pays for four out of every five babies that are
    suffering from opioid withdrawal upon their birth. It has
    helped 1.6 million people with substance abuse disorders and
    access to treatment.
        And I just really more than anything want to make the point
    that Medicaid has to be protected and not cut.
        I want to stress one other point because of the
    congressional district that I represent and that is that the
    opioid crisis is actually worse in rural communities where the
    drug-related deaths are actually 45 percent higher.
        Rural States have higher rates of overdose, especially
    prescription opioids like the kind that Chris had been
    prescribed for his back injury.
        So, you know, we don't have the resources to fight back at
    the level that we need to. We don't have enough physicians in
    rural America.
        We don't have enough hospitals that are--with up-to-date
    technology to help with this crisis. We don't even have the
    needed transportation to reach these treatment centers.
        So that is why earlier this year I introduced bipartisan
    piece of legislation to help rural communities better leverage
    the U.S. Department of Agriculture programs to combat heroin
    and opioid use.
        So we need to continue to look at solutions that work in
    rural areas like telemedicine, which will help us overcome the
    transportation and access issues that I mentioned earlier.
        With that, Mr. Chairman, I yield back the rest of my time.
    Thank you.
        [The prepared statement of Mrs. Bustos follows:]

                    Prepared statement of Hon. Cheri Bustos

        Thank you Chairman Walden and Ranking Member Pallone.
        Let me tell you about a young man from Rockford, Illinois
    named Chris Boseman.
        Chris passed away in the summer of 2014. He was 32 years
    old.
        He was a kind, tender-hearted son and brother. A back
    injury led to a painkiller prescription that he soon became
    dependent on.
        And when he could no longer fill that prescription, he
    began buying pain medication on the street.
        But as the costs added up, his dealer told him that heroin
    would give him the same effects . for only $10.
        After a continuing cycle of overdose, rehab, and relapse,
    Chris was enrolled in Rock Valley College and studying
    construction management when, after a year of being clean, he
    relapsed and died.
        This is happening every day, all across the country.
        I was proud that Congress came together last summer to pass
    legislation that helps communities address the opioid crisis.
        Which included my bill to improve care for infants born
    with an opioid dependency due to their parents' addiction.
        In fact, we just received the GAO's report that my bill
    called for.
        It reviews and makes recommendations to care for these
    infants. But really what it shows is that we have a long way to
    go.
        HHS has a strategy for improving infant care.
        But they haven't put it into practice yet.
        There is not even a protocol to screen and treat these
    newborn babies who, through no fault of their own, are
    addicted.
        Which further reinforces that this is not the time to cut
    Medicaid, which pays to treat over 80 percent--that's four out
    of every five--of our newborns suffering from opioid
    withdrawal.
        And helped 1.6 million people with substance abuse
    disorders to access treatment.
        It has dropped the uninsured rate for the mentally ill down
    to 5 percent in expansion States.
        Medicaid must be protected, not cut.
        And I want to stress another point: the opioid crisis is
    worse in rural communities, where drug-related deaths are 45
    percent higher.
        Rural States have higher rates of overdose, especially from
    prescription opioids like the kind Chris was given by his
    doctor.
        And we just don't have the resources to fight back.
        We don't have enough doctors.
        We don't have hospitals with up-to-date technology and
    services.
        And we don't have public transportation to reach the right
    treatment centers.
        That is why earlier this year I introduced bipartisan
    legislation to help rural communities better leverage USDA
    programs to combat opioid and heroin use.
        We need to continue to look at solutions that work in rural
    areas, like telemedicine, which will overcome transportation
    and access issues.
        Thank you. I am happy to yield back.

        Mr. Burgess. Chair thanks the gentlelady. Gentlelady yields
    back.
        Chair recognizes the gentleman from Dayton, Ohio, Mr.
    Turner, for 3 minutes, please.

       STATEMENT OF HON. MICHAEL R. TURNER, A REPRESENTATIVE IN
                    CONGRESS FROM THE STATE OF OHIO

        Mr. Turner. Thank you, Chairman Burgess, Ranking Member
    Green, and members of the subcommittee. I want to thank you for
    the opportunity to appear before you today on this important
    issue.
        As the chairman said, I come from Dayton, Ohio. My counties
    in Ohio are Montgomery, Greene, and Layette, and despite our
    communities' efforts to battle the opioid epidemic for years,
    the epidemic continues to destroy my community and my
    constituents on a daily basis.
        This year, current estimates suggest that 800 people could
    die in my primary county--Montgomery County--due to opioid
    overdose. Sadly, that would more than double the 371 drug
    overdose deaths from 2016, the highest number recorded to date.
    Imagine 800 families receiving notice that someone in their
    family has died as a result of opioid overdose.
        Heartbreaking numbers like this have made Montgomery
    County, Ohio, ground zero in the fight against opioid abuse and
    addiction.
        Recently, in working in conjunction with the county sheriff
    I have called for the appointment of a Dayton area drug czar to
    help us streamline and coordinate our region's response to this
    epidemic.
        While I have worked on a local basis to help stem this
    tide, today I would like to highlight my bill, H.R. 982, the
    Reforming and Expanding Access to Treatment Act--the TREAT Act.
        As the title suggests, the TREAT Act would increase access
    to substance abuse treatment by lifting two restrictions that
    hamstring full deployment of Federal resources.
        Medicaid's Institutions for Mental Disease Exclusion States
    that facilities with more than 16 beds, like jails, are not
    eligible for reimbursement for substance abuse treatment
    services furnished to individuals who are incarcerated.
        Composing the problem, a Substance Abuse and Mental Health
    Administration Policy dating to 1995 limits the use of grants
    from its Center for Substance Abuse Treatment--CSAT--to only
    community-based treatment facilities excluding those who are
    incarcerated.
        My Treatment Act offers a common sense solution that would
    eliminate these barriers to treatment for individuals who are
    incarcerated by allowing Medicaid to reimburse for substance
    abuse treatment services furnished to individuals who are
    incarcerated. There is not reason why someone who is Medicaid
    eligible should lose their benefits the moment they become
    incarcerated.
        Limiting the SAMHSA policy that prohibits the use of grant
    funding for providing substance abuse treatment to individuals
    who are incarcerated would also assist.
        Since I first introduced the TREAT Act in November of 2015
    and then reintroduced it in this Congress it has garnered a
    broad spectrum of support from law enforcement to medical
    providers to local jurisdictions.
        The President's Commission on Combatting Drug Addiction and
    the Opioid Crisis Interim Report, which was just issued July
    31st, 2017, strongly endorsed this concept that is in the TREAT
    Act.
        The White House Commission called lifting Medicaid's IMD
    exclusions, quote, ``the single fastest way to increase
    treatment availability across the Nation, noting that every
    Governor, numerous treatment providers, parents, and nonprofit
    advocacy group organizations have urged this course of
    action.''
        Chairman Burgess, Ranking Member Green, and members of the
    subcommittee, lives are at stake. This would be an important
    step to bring treatment to those individuals who are at a time
    we have an ability to intervene in their lives.
        Thank you.
        [The prepared statement of Mr. Turner follows:]

                  Prepared statement of Hon. Michael R. Turner

        Chairman Burgess, Ranking Member Green, and members of the
    subcommittee, thank you for the opportunity to appear before
    you today.
        I am Congressman Michael R. Turner, and I proudly represent
    Ohio's 10th Congressional District, which centers around the
    city of Dayton and includes Montgomery, Greene, and Fayette
    counties.
        This morning, I will briefly explain how the opioid
    epidemic is ravaging the district I serve and propose possible
    solutions to what has become a national crisis of frightening
    proportions.
        Despite battling against it for years, the heroin and
    opiate epidemic continues to destroy my community and my
    constituents on daily basis.
        This year, current estimates suggest that 800 people could
    die in Montgomery County alone due to an opiate overdose.
    Sadly, that would more than double the 371 drug overdose deaths
    from 2016, the highest number recorded to date.
        The Montgomery County morgue regularly surpasses capacity
    and has even been forced to use refrigerated trailers to house
    victims' bodies. The coroner has described what is occurring as
    a ``mass-casualty event.''
        To make matters worse, deadly synthetic opioids like
    fentanyl, which can be 50 times stronger than heroin, and
    carfentanil, which can be 5,000 times stronger, have flooded
    the Miami Valley.
        It is heartbreaking numbers and stories like these that
    have made Montgomery County, Ohio ``the overdose capital of
    America''--meaning that, per capita, more of my Montgomery
    County constituents are dying as a result of drug overdoses
    than anywhere else in the United States.
        Our struggle in southwestern Ohio mirrors that of countless
    other areas across the country--91 Americans die every day as
    the result of an opioid overdose.
        These sobering statistics paint a picture of a country
    facing an exponentially growing epidemic of opioid abuse that
    is resulting in drastic increases in addiction rates, overdose
    deaths, and incarceration. The opiate crisis is tearing apart
    families, neighborhoods, cities, and indeed our society as a
    whole.
        While I have spearheaded several initiatives--in
    conjunction with State and local partners--to stem the tide of
    the opioid epidemic, today I would like to highlight my bill
    H.R. 982, The Reforming and Expanding Access to Treatment
    (TREAT) Act.
        As the title suggests, my TREAT Act would increase access
    to substance abuse treatment by lifting archaic restrictions
    that hamstring full deployment of Federal resources.
        The concept behind my TREAT Act originated from a tour of
    my district's Greene County Jail and Green Leaf Alcohol & Drug
    Treatment Program in August 2015.
        During the visit, I discovered that individuals who are
    incarcerated cannot receive substance abuse treatment through
    Medicaid, even if they are otherwise eligible.
        This is due to Medicaid's Institutes for Mental Disease
    (IMD) exclusion, which states that facilities with more than 16
    beds--like jails--are not eligible for reimbursement for
    substance abuse treatment services furnished to individuals who
    are incarcerated.
        Compounding the problem, the Substance Abuse and Mental
    Health Administration (SAMHSA) currently prohibits the use of
    grants from its Center for Substance Abuse Treatment (CSAT) for
    substance abuse treatment services provided to individuals who
    are incarcerated. Instead, this over 20-year-old policy limits
    use of such grants to only community-based treatment
    facilities.
        These unnecessary restrictions act as obstacles, limiting
    our flexibility in how we employ the Federal resources that are
    so desperately needed to combat this growing epidemic and
    supply medical treatment to individuals suffering from
    substance abuse disorders and addiction.
        My TREAT Act offers a common-sense solution that would
    eliminate these barriers to treatment for individuals who are
    incarcerated by:
         Allowing Medicaid to reimburse for substance abuse
    treatment services furnished to individuals who are
    incarcerated; and
         Lifting the SAMHSA policy that prohibits the use
    of grant funding for providing substance abuse treatment to
    individuals who are incarcerated.
        Since I first introduced the TREAT Act in November 2015 and
    reintroduced it this Congress, it has garnered a broad spectrum
    of support from law enforcement to medical providers to local-
    level jurisdictions.
        The President's Commission on Combating Drug Addiction and
    the Opioid Crisis' Interim Report, issued July 31, 2017,
    strongly endorsed the TREAT Act's core concept.
        The White House Commission called lifting Medicaid's IMD
    exclusion the ``single fastest way to increase treatment
    availability across the Nation,'' noting that ``every Governor,
    numerous treatment providers, parents, and nonprofit advocacy
    organizations'' have urged this course of action in an effort
    to combat the opioid epidemic.
        Chairman Burgess, Ranking Member Green, and members of the
    subcommittee, my constituents' lives and indeed the well-being
    of my entire community are at stake here, as are many of yours.
    They are under assault from an opioid epidemic, the likes of
    which have never been seen.
        My TREAT Act can help put an end to the opiate crisis-but
    it cannot wait any longer. I urge you to work with me to report
    the TREAT Act out of committee, and support its passage in the
    House of Representatives.
        Thank you for the opportunity to speak with you today, and
    I look forward to addressing any questions or concerns you may
    have.

        Mr. Burgess. Chair thanks the gentleman. The gentleman
    yields back.
        Chair recognizes the gentleman from Kansas, Dr. Marshall,
    for 3 minutes.

       STATEMENT OF HON. ROGER W. MARSHALL, A REPRESENTATIVE IN
                   CONGRESS FROM THE STATE OF KANSAS

        Mr. Marshall. Thank you, Chairman, very, very much.
    Appreciate--thank you, Chairman, for the opportunity to come
    and talk and share some of my 30 years of experience as an OB/
    Gyn in rural Kansas.
        As most of the members of the committee know, 92 people die
    in this country every day. Ninety-two people die in this
    country every day from opioid addiction.
        What I wanted to do was describe a couple sentinel events.
    Why? Why did we end up in this situation? And as I--as I look
    back in these last 10 years, the number of pills that I would
    send home for a post-op patient doubled.
        For the average C-section, the average hysterectomy, all of
    a sudden each week, to get the people to that post-op visit the
    number of pills they would need literally doubled.
        So I went back to try to figure out why and how come, and
    the first thing I think of, the Patient Bill of Rights came
    about 1993 or so, and over the next 10 years, though it was a
    great document, patients suddenly began to expect that they
    should have no pain--no pain after surgery. They would come
    into the ER with a sprained ankle and expect to have no pain
    and the demand for narcotics went up and up.
        Somewhere in the early 2000s, something was introduced
    called a pain scale and they called it the fifth vital sign. It
    is probably the worst thing I've ever seen introduced in my
    medical career where they suddenly described the amount of
    pain, which is very subjective, and beyond that it eventually
    became part of a measure of how good a medicine you were
    practising, even tied to your reimbursement.
        So suddenly patients in the post-op PACU area were getting
    double and triple the medications, and then on the post-
    operative floor, rather than getting Percocets every 6 hours,
    they were getting them every 4 hours and the PCA pumps
    increased doses.
        So what I am trying to say is we almost doubled the amount
    of narcotics people were getting in the hospital and then they
    wanted twice the amount to go home with as well.
        So physicians were faced with this struggle of saying well,
    I don't think you need this much, but patients becoming more
    and more in control of how many--of their own health care.
        So I think those are a couple of reasons why we ended up
    here and I think there needs to be some reeducation done. I
    would like to point towards Valley Hope at Norton, Kansas. They
    have treated over 300,000 patients over the past 50 years. They
    have kept incredible statistics. They have incredible treatment
    plans.
        And what they taught me is about a month after release--a
    month after they started their Path to Recovery that they had a
    second physiological reaction and that is when they--these
    people OD and die. People need to recognize that for a month
    that they need to have very close treatment and probably for
    two months, then even a year.
        So it's during that second episode when they--when before
    they had treatment they were taking a certain amount of heroin
    and a handful of pills and a pint of whiskey. When they
    retreated from that for a month and they went back to that same
    dose, they overdosed and stopped dying.
        We need to understand what kills people is that--that if I
    gave anybody enough morphine you would stop breathing. So they
    are unable to metabolize it. We need to recognize that that is
    a very critical moment. Treatment plans cannot last a week.
        They're going to last months and years probably. We need to
    make sure we are adequately funding outpatient treatment and
    that we are making sure that there is good follow-up at home
    and we need to reward facilities like Valley Hope who have
    great outcomes--great long-term outcomes.
        Mr. Chairman, thank you so much for taking on this task and
    look forward to working with you, as always.
        [The prepared statement of Mr. Marshall follows:]

                  Prepared statement of Hon. Roger W. Marshall

        As a practicing physician for nearly 3 decades, and now a
    freshman Congressman, I have had a unique perspective from
    which to understand the causes, and to identify solutions for
    the opioid crisis we face.
        Over the last decade, it has become clear that many actions
    taken by the medical community to better-address pain, such as
    pain-scales, and stronger pain treatments for chronic diseases
    or cancer, have helped fuel an opioid epidemic that is killing
    an unprecedented number of Americans.
        While we began to improve the restrictions on prescribing
    these painkillers, tens of thousands of addicted people turned
    to street-level drugs as cheap, potent alternatives.
        Today, I don't pretend to have all the answers or solutions
    to this complex situation, but there are some simple things
    already being done that have proven successful.
        One part of the solution is quality community addiction
    treatment. For 50 years, Valley Hope in Norton, KS, has treated
    over 300,000 patients. They address substance-abuse as a
    chronic health care problem, just like you would treat
    hypertension or diabetes. They don't treat it as some sort of
    moral deficiency.
        Valley Hope also recognizes that opioid addiction has a
    second withdrawal about a month after stopping the use of
    narcotics. It is that secondary withdrawal that patients are
    most likely to overdose. Patients go back to taking the amount
    of drugs they usually took to get high. Their bodies cannot
    metabolize like they used to, and the patient overdoses and
    stops breathing.
        The key to avoiding these disasters is to maintain contact
    through weekly follow ups and outpatient checkups. The future
    treatment for opioid abuse will be found in rewarding good
    outpatient management, and institutions that pride themselves
    in low rates of readmission and relapse.
        Solving this crisis begins in the doctor's office.
    Physicians, nurses and patients must all be willing to
    understand the potential for addiction when the prescribe,
    administer or take medications.
        When we pair this understanding with capable community
    treatment, along with respect, compassion and empathy toward
    those suffering, we will have taken the first steps to overcome
    this challenge.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        The Chair recognizes the gentleman from Ohio, Chairman
    Stivers, for 3 minutes.

     STATEMENT OF HON. STEVE STIVERS, A REPRESENTATIVE IN CONGRESS
                         FROM THE STATE OF OHIO

        Mr. Stivers. Thank you very much, Mr. Chairman. I
    appreciate you holding this hearing. Appreciate Ranking Member
    Green and all of you looking at solutions that--for this opioid
    crisis that is plaguing all of the communities across this
    country.
        Congressman Turner already alluded to it, but in Ohio
    opioid overdoses now exceed car accidents as the leading cause
    of death for most Ohioans.
        And there have been a lot of great ideas presented here
    today and I really have appreciated learning from many of our
    colleagues.
        I, for the last 5 years, have held opioid round tables--
    drug round tables in my district to talk about solutions and we
    have come up with some ideas from the field of folks that know
    what is driving this crisis.
        And I will talk about some medical things in a second but
    the first thing I know we have to do is bring back hope and
    economic opportunity to people and I think what you are doing,
    Mr. Chairman, with regulatory reform and what we are doing with
    tax reform is going to help with that.
        But there are a lot of other things we can do. First, you
    know, the idea that came out of our round table this year was
    on evidence-based treatment. If you've been to one treatment
    facility you have been to one treatment facility, because they
    all do things differently.
        Too many of them do things that when you walk out that
    door, there is nothing tying you to the treatment anymore and
    that is a problem, and they need to--I think we should have
    evidence-based treatment.
        It should be based on the science of the day and how
    recovery works, and I think we need to build that into our
    reimbursement standards. I think that is so important.
        Dr. Marshall already talked about the second issue I want
    to bring up, which is pain as a vital sign. Every other vital
    sign you can think of--you know, your temperature, your blood
    pressure, your pulse--can be measured by a machine. Pain can't
    be measured by a machine.
        It is a subjective number and it should not be the fifth
    vital sign. It has led to our over prescribing culture in this
    country and we have to try to fix it.
        I appreciate what CMS has done to remove the reimbursement
    based on the surveys of pain management. But I think we need to
    remove pain as a vital sign.
        The third idea is encouraging alternatives. There is lots
    of ways to manage pain including acupuncture, chiropractic
    services, and other things that don't involve a pill and I
    think we need to change the culture on that.
        The fourth idea is some prescription changes and I know
    that Buddy Carter, who is a pharmacist, talked about a couple
    of these. I sponsored the partial fill legislation that was
    rolled into CARA and became law. But I believe that pharmacists
    should be empowered to authorize partial fill of opioid
    prescriptions on their own.
        And Buddy already said it, but 70 percent of the folks who
    misuse prescriptions get it at some point--bridge that
    addiction through their friends' and families' medicine
    cabinets and we have got to fix that.
        The final issue that I don't hear talked about enough is
    tapering doses. When somebody is on an opioid for about 30
    days, they have a physical addiction to it and if you talk to
    most pharmacists they will talk about a tapering does instead
    of going off cold turkey, and I think that is something we need
    to bring a culture around of having folks understand that
    because a lot of primary care physicians, Mr. Chairman, feel
    very uncomfortable with doing--issuing more prescriptions but a
    tapering does actually will reduce the physical addiction and
    actually will result in less people wanting to feed that
    addiction in other ways.
        So those are just five ideas of some proposed solutions.
    Many of my colleagues also have great ideas. I really
    appreciate, Mr. Chairman and Ranking Member, you holding this
    hearing and we are committed to working with you to driving
    this scourge of drug addiction out of this country, and I
    really appreciate what you are doing.
        I yield back.
        [The prepared statement of Mr. Stivers follows:]

                    Prepared statement of Hon. Steve Stivers

        Thank you Chairman Burgess and Ranking Member Green for
    having this hearing today to discuss solutions for addressing
    the opioid crisis plaguing communities across America.
        We have seen drug overdoses surpass traffic accidents as
    the leading cause of accidental death in the United States.
        This issue affects everyone--no matter your race, income
    level, gender, or political party. We need to work together to
    curb this epidemic.

                                  My District

        Ohio has been devastated by this crisis. In 2016, 4,050
    Ohioans died from an unintentional drug overdose. This was a
    32.8 Percent increase from 2015 (3,050).
        In my district alone, there were 112 overdose deaths in
    2015, according to the Ohio High Intensity Drug Trafficking
    Area.
        Because of how much this has affected my district, I have
    held roundtables for the past 5 years to bring together people
    from all sides of the issue to discuss how we can better work
    together to address this issue in Ohio.

                            Evidence-Based Treatment

        In one of my recent roundtables, we discussed how we need
    to ensure that we support only the treatments that are proven
    to work and are evidence-based.
        Based on these discussions, we have learned of a serious
    need to raise the evidenced based standards that are used in
    approving treatment programs that are largely funded by the
    Federal Government and administered at the local level.
        The Ohio Department of Mental Health and Addiction Services
    estimates that almost 500,000 Ohioans receive publicly funded
    mental health services, which includes addiction treatment,
    every year.
        Whether it be a discrepancy between accreditation
    standards, or inadequate reporting requirements, Congress
    should be ensuring that Federal funds going to Ohio, and to my
    district, are going towards treatments that are based on a
    foundation of evidence as to its efficacy.
        Simultaneously, we need to promote data collection and
    research in order to better inform our evidence-based efforts
    over time, so that we do not discourage emergent therapies and
    can justify deploying innovative approaches that can meet this
    epidemic head on.

                              Pain as a Vital Sign

        Another issue we discussed is removing pain as the fifth
    vital sign and finding ways to change the culture surrounding
    pain management and the overprescription of opioids.
        Pain being considered a vital sign can, in some cases, lead
    to the overprescribing of opioids by focusing on pain
    management instead addressing and treating the underlying
    causes of pain.
        This culture of overprescribing has also been found in
    patient-reported satisfaction scores. On these surveys, ``pain
    management'' is a section doctors and hospitals have been
    scored on.
        Poor marks in satisfaction scores can lead to lower
    reimbursements for these doctors and hospitals, and this
    attempt to manage pain, while well intentioned, created a
    perverse incentive that led to some health care professionals
    to work towards a score, rather than the best overall health of
    the patient.
        Recently, CMS has announced that they will no longer be
    directly tying these ``pain management'' questions to the
    Hospital Value-Based Purchasing Program, starting next year.
        I am encouraged by CMS's recent actions. By building upon
    these actions and working to remove the use of pain as a vital
    sign, we can remove the incentive to overprescribe opioids to
    patients, and rather focus on prescribing them when they are
    absolutely necessary. I implore the committee to learn from
    this example to ensure further policies are always focused on
    the long term health of the patient over short term benchmarks
    and quotas.

                            Encouraging Alternatives

        As we seek to change the culture of pain management, we
    also need to find ways to support and bolster alternative
    methods for treating and managing pain--outside of opioids.
        This can include treatment options such as chiropractic
    services and acupuncture.
        There is no doubt that we should ensure patients can
    receive the medicine they need, but overreliance as a quick and
    easy fix must be discouraged when there are other alternatives
    that could be used.

                              Tapering Opioid Use

        Furthermore, as you know, last year, the passage of the
    Comprehensive Addiction and Recovery Act (CARA) was one of the
    highlights in the fight against opiate addiction.
        Language from my legislation, the Reducing Unused
    Medications Act was included in the final passage of CARA. This
    bill allows for the partial fill of prescriptions at the
    request of patients or doctors, reducing the number of unused
    painkillers that can be abused or diverted.
        With more than 70 percent of adults who misuse prescription
    opioids getting them from medicine cabinets of friends or
    relatives, we needed to reduce unused medications in homes.
        Now, we need build on that legislation. One way to do that
    is to focus on supporting better education and protocols for
    physicians to taper down the dosages of prescribed opioids over
    the course of treatment.
        This approach must be specific to each patient, and we
    should be finding ways to encourage better conversations about
    pain management between patients, their doctors, and their
    pharmacists.
        I look forward to working with this committee to find
    better ways to better inform patients of resources and tools at
    their disposal--like partial fill opportunities--and giving
    physicians more freedom to address pain management at an
    individual level.

                                    Closing

        There is no single legislative fix for the opioid epidemic.
    We need to keep pushing to find ways to better prevent opioid
    abuse and treat those who are suffering from addiction.
        Those are just a few of the proposed solutions I am
    advocating, and I hope I can continue working with everyone on
    this committee to craft legislation that delivers relief to
    Ohio's 15th District and all communities suffering from this
    epidemic.
        Again, I want to thank the chairman and ranking member for
    having this important hearing. I lookforward to working with
    everyone on solutions to stop the opioid epidemic in our
    country.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back, and I want to thank all of you for providing your
    testimony today.
        This panel is excused, and our next panel will be Dr.
    Wenstrup from Ohio, Mr. Schneider from Illinois, Ms. Clark from
    Massachusetts, Mr. Jeffries from New York, and Mr. Jenkins from
    West Virginia.
        And Representative Schneider, you are recognized for 3
    minutes.

    STATEMENT OF HON. BRADLEY SCOTT SCHNEIDER, A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF ILLINOIS

        Mr. Schneider. Thank you. Thank you, Chairman Burgess,
    Ranking Member Green, for inviting me here today to discuss the
    epidemic of opioid addiction abuse and overdose that is
    ravaging our communities.
        I represent the people of Illinois' 10th District including
    parts of Cook and Lake Counties, and the opioid crisis has hit
    our neighbourhoods extremely hard.
        In Cook County, which includes the city of Chicago, opioid
    overdoses increased by 87.4 percent--I repeat that, 87.4
    percent--between 2013 and 2016.
        Over the same period, we witnessed a troubling increase in
    fentanyl, a synthetic opioid which is even more deadly than
    heroin and whose overdoses are often fatal.
        In the face of these challenges, I would like to recognize
    the Lake County Opioid Initiative and Chicago area Opioid Task
    Force along with other area organizations for their work to
    prevent opioid abuse, addiction, overdose, and health--and
    death, rather.
        In this epidemic, our adversary is constantly shifting. So
    must ensure our doctors are up to date with the most recent
    best practices and research for preventing and treating this
    disease.
        Earlier this year, I introduced a bill called the
    Preventing Opioid Abuse Through Continuing Education, or Opioid
    PACE Act. This bill would require providers who treat patients
    will prescription opioids for pain management to complete 12
    hours of continuing education every 3 years.
        This would be linked to renewal of the providers' Drug
    Enforcement Agency license. In an effort to cut down on over
    prescribing, the CME would focus on pain management treatment
    guidelines and best practices, early detection of opioid use
    disorder, and the treatment and management of patients with
    opioid use disorder.
        I am proud that a modified version of this bill requiring
    continuing education of medical professionals at the Department
    of Defense was included as an amendment to the NDA
    authorization.
        Our men and women in uniform are not immune from the
    damages of opioid addiction. In fact, the National Institute of
    Health reports rates of prescription opioid misuse are higher
    among service members than among civilians due to the use of
    these drugs to treat symptoms of PTSD and chronic pain.
        As we seek new legislative solutions, I urge my colleagues
    to support these programs we have in place to fight back. In
    particular, the Affordable Care Act greatly increased our
    ability to counter opioid epidemic by expanding Medicaid and
    requiring individual market policies that they would cover
    services related to treating substance use disorders.
        The States with the highest rates of drug overdose deaths
    are also the States that would suffer from a rollback of
    Medicaid expansion.
        Simply put, repealing the ACA would add fuel to the fire of
    the opioid epidemic. I urge my colleagues to consider new
    solutions to address this crisis including the Opioid PACE Act
    and preserve the programs we have in place to address this
    epidemic.
        And with that, I yield back.
        [The prepared statement of Mr. Schneider follows:]

               Prepared statement of Hon. Bradley Scott Schneider

        Thank you, Chairman Burgess and Ranking Member Green, for
    inviting me here today to discuss the epidemic of opioid
    addiction, abuse, and overdose that is ravaging our
    communities.
        I represent the people of Illinois' 10th District including
    parts of Cook and Lake Counties, and the opioid crisis has hit
    our neighborhoods hard. In 2015, there were 42 heroin-related
    deaths in Lake County, a seven-percent increase over the
    previous year. In Cook County, which includes the City of
    Chicago, opioid overdoses increased by 87.4 percent between
    2013 and 2016. Over the same period, we've witnessed a
    troubling increase in fentanyl--a synthetic opioid which is
    even more deadly than heroin and whose overdoses are often
    fatal.
        In the face of these challenges, I'd like to recognize the
    Lake County Opioid Initiative and Chicago Area Opioid Task
    Force, along with other area organizations, for their work to
    prevent opioid abuse, addiction, overdose, and death.
        In this epidemic, our adversary is constantly shifting, so
    we must ensure our doctors are up-to-date with the most recent
    best practices and research for preventing and treating this
    disease.
        Earlier this year I introduced a bill called the Preventing
    Opioid Abuse Through Continuing Education or Opioid PACE Act,
    that would require providers who treat patients with
    prescription opioids for pain management to complete 12 hours
    of continuing medical education (CME) every 3 years, linked to
    the renewal of the provider's Drug Enforcement Agency (DEA)
    license.
        In an effort to cut down on overprescribing, the CME would
    focus on pain management treatment guidelines and best
    practices, early detection of opioid use disorder, and the
    treatment and management of patients with opioid use disorder.
        I'm proud that a modified version of this bill requiring
    continuing education medical professionals at the Department of
    Defense was included as an amendment in the National Defense
    Authorization Act. Our men and women in uniform are not immune
    from the damages of opioid addiction. In fact, the National
    Institute of Health reports rates of prescription opioid misuse
    are higher among service members than among civilians due to
    the use of these drugs to treat the symptoms of PTSD and
    chronic pain.
        As we seek new legislative solutions, I urge my colleague
    to also support the programs we have in place to fight back.
        In particular, the Affordable Care Act greatly increased
    our ability to counter the opioid epidemic by expanding
    Medicaid and requiring individual market policies cover
    services related to treating substance use disorders.
        The States with the highest rates of drug overdose deaths
    are also the States that would suffer from a rollback of the
    Medicaid expansion. Simply put, repealing the ACA would add
    fuel to the fire of the opioid epidemic.
        I urge my colleagues to consider new solutions to address
    this crisis--including the Opioid PACE Act--and preserve the
    programs we have in place to counter the epidemic.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Chair recognizes Representative Jeffries from New York for
    3 minutes, please.

       STATEMENT OF HON. HAKEEM S. JEFFRIES, A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF NEW YORK

        Mr. Jeffries. Thank you, Chairman Burgess and Ranking
    Member Green, for holding this hearing as well as for your
    leadership on this very important issue. Appreciate the
    opportunity to testify today on the Synthetic Drug Awareness
    Act of 2017--H.R. 449.
        The opioid crisis has ravaged families across the country
    without regard to zip code, income, race, religion, or gender.
    Like a malignant tumor, the opioid crisis is eating away at
    young people in urban American, rural America, as well as
    suburban America.
        One reason the opioid abuse has become so prevalent and so
    deadly is the emergence of the synthetic drug called fentanyl,
    a substance that can be 50 to 100 times stronger than morphine.
        In order to address the multifaceted public health crisis
    we confront, it's important to consider both the cause and
    effect. H.R. 449 addresses a critical and sometimes overlooked
    threat--the use of synthetic drugs by teenagers.
        It requires the surgeon general to prepare a comprehensive
    report on the public health effects of synthetic drug abuse by
    12-to-18-year-olds in America.
        With the information the study will provide, Congress can
    work to prevent substance abuse by younger Americans through an
    enhanced and enlightened lens. Nationwide, the drug overdose
    death rate has more than doubled during the past decade among
    younger Americans.
        Many experts believe this troubling phenomenon results from
    the rise and availability of potent and dangerous substances
    like illicit fentanyl and other synthetic drugs.
        Teenage fentanyl use is a vicious cycle. Adolescents have a
    still developing prefrontal cortex which can facilitate drug-
    seeking behavior. The drug then alters the development of this
    area of the young brain, making that behavior permanent.
        In fact, more than 90 percent of adults who develop a
    substance abuse disorder begin using prior to the age of 18. In
    New York City, overdoses now kill more people each year than
    murder, suicides, and car crashes combined. This phenomenon we
    have seen repeated over and over again all across America.
        This bill has significant support amongst Republicans and
    Democrats and has been incorporated into the legislative agenda
    for the bipartisan Heroin Task Force. It also has support from
    a number of health and patient advocacy groups including the
    American Academy of Pediatrics, American Association of Nurse
    Practitioners, as well as the National Association of Police
    Organizations.
        Thank you again for this opportunity to testify and I
    respectfully respect committee consideration at your earliest
    convenience.
        [The prepared statement of Mr. Jeffries follows:]

                 Prepared statement of Hon. Hakeem S. Jeffries

        Let me first thank the leadership of the Energy and
    Commerce Committee, Chairman Walden and Ranking Member Pallone,
    and of the Subcommittee on Health, Chairman Burgess and Ranking
    Member Green, as well as the distinguished Members of the
    Energy and Commerce Committee for holding this hearing. I
    appreciate the opportunity to testify today on the ``Synthetic
    Drug Awareness Act of 2017''-H.R. 449.
        The opioid crisis has ravaged families across the country
    without regard to zip code, income, race religion or gender.
    Like a malignant tumor, the opioid crisis is eating away at
    young people in urban, rural and suburban America. One reason
    opioid abuse has become so prevalent, and so deadly, is the
    emergence of the synthetic drug called fentanyl-a substance
    that can be 50 to 100 times stronger than morphine.
        In order to address the multifaceted public health crisis,
    we must consider both the cause and effect. H.R. 449 addresses
    a critical and sometimes overlooked threat, the use of
    synthetic drugs by teenagers. It requires the Surgeon General
    to prepare a comprehensive report on the public health effects
    of synthetic drug use by 12-to-18-year-olds in America. With
    the information this study will provide, Congress can work to
    prevent substance abuse by younger Americans through an
    enhanced and enlightened lens.
        Nationwide, the drug overdose death rate has more than
    doubled during the past decade among younger Americans.1 Many
    experts believe this troubling phenomenon results from the rise
    and availability of potent and dangerous substances like
    illicit fentanyl and other synthetic drugs.
        Teenage fentanyl use is a vicious cycle: adolescents have a
    still-developing prefrontal cortex, which can facilitate drug-
    seeking behavior. The drug then alters the development of this
    area of the brain, making that behavior permanent. In fact,
    more than 90 percent of adults who develop a substance abuse
    disorder begin using before they are 18 years old.
        In New York City, overdoses kill more people each year than
    murders, suicides and car crashes combined. Between 2015 and
    2016, city officials saw a huge jump in overdose-related
    deaths, with more than eight in ten involving an opioid, a
    trend driven by fentanyl.3
        This bill has significant support among Republicans and
    Democrats and has been incorporated into the legislative agenda
    for the Bipartisan Heroin Task Force. Furthermore, a number of
    health and patient advocacy groups are supportive of this bill,
    including the American Academy of Pediatrics, American
    Association of Nurse Practitioners, American Academy of Child &
    Adolescent Psychiatry, American Psychological Association,
    College on Problems of Drug Dependence, Community Anti-Drug
    Coalitions of America, Friends of the National Institute on
    Drug Abuse, Healthy Teen Network, Mental Health America,
    National Association of County and City Health Officials and
    National Association of Police Organizations.
        Thank you again for the opportunity to testify today, and I
    respectfully request committee consideration of the ``Synthetic
    Drug Awareness Act'' at the earliest possible time.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Chair recognizes the gentleman from West Virginia, Mr.
    Jenkins, for 3 minutes, please.

    STATEMENT OF HON. EVAN H. JENKINS, A REPRESENTATIVE IN CONGRESS
                    FROM THE STATE OF WEST VIRGINIA

        Mr. Jenkins. Thank you so much, Chairman Burgess, Ranking
    Member Green, and members of the subcommittee for giving me the
    opportunity to discuss this most challenging public health and
    safety issue of our time.
        My home State of West Virginia is ground zero for the
    opioid epidemic. West Virginia has the Nation's highest
    overdose rate and the highest rate of newborns exposed to
    opioids and other drugs known as neonatal abstinence syndrome,
    or NAS.
        From this tragic epidemic, however, has come an exceptional
    response from communities across my State coming together to
    find solutions. One shining example is Lilly's Place, a unique
    facility that specializes in treating newborns suffering from
    NAS.
        I was proud to work with two NICU nurses and a passionate
    community leader to start Lilly's Place after they saw, we saw,
    the dramatic rise in newborns with NAS. Lilly's Place has been
    operating for 3 years and has cared for more than 190 precious
    newborns.
        Lilly's Place has brought national attention to West
    Virginia solutions. Just yesterday, the First Lady, Melania
    Trump, visited Lilly's Place in my hometown of Huntington to
    talk with the caregivers about helping the most vulnerable in
    our society. Lilly's Place provides a great environment with
    are given by doctors and nurses in a nurturing setting
    conducive to recovery.
        Mothers and families are included in the healing process.
    Lilly's Place and others advocating for this model of care had
    struggles dealing with CMS, making it harder to replicate this
    model.
        That led to my introduction of the Nurturing and Supporting
    Healthy Babies Act. Last year through this committee's work my
    legislation was incorporated in CARA, which, of course, became
    law and was passed. Thank you for your work.
        My legislation requiring GAO to closely look at the
    different care models for NAS and Medicaid coverage and the GAO
    report was just released last week.
        It found that nonhospital settings like Lilly's Place are a
    proven model of care to treat NAS newborns. It identified this
    model of care as a proven effective treatment approach and can
    actually reduce the cost of care.
        Here is my ask. I would encourage this committee to advance
    two measures critical to the care of these precious newborns.
    First, I have sponsored the CRIB Act pending before this
    committee with Congressman Mike Turner which makes sure these
    models of care are included in nonhospital treatment facilities
    are recognized by Medicaid to remove the barriers.
        Second, based on the GAO report, I ask you, working with
    me--this committee--to memorialize in legislation the
    recommendations in this report and have these become law so
    these precious newborns can receive the very best possible
    care.
        Thank you, Mr. Chairman, for your interest in this issue,
    and I yield back.
        [The prepared statement of Mr. Jenkins follows:]

                   Prepared statement of Hon. Evan H. Jenkins

        Thank you, Chairman Burgess, Ranking Member Green, and
    members of the subcommittee, for giving me the opportunity to
    discuss the most challenging public health crisis of our time.
    States and communities across this country have been dealing
    with the ravages of opioid and drug addiction. This is not a
    rural or urban problem, it is a crisis that has hit cities and
    small towns alike.
        West Virginia has been ground zero for the opioid epidemic.
    The statistics speak for themselves. West Virginia has the
    highest overdose death rate, we have the highest rate of
    newborns exposed to opioids and other drugs known as Neonatal
    Abstinence Syndrome or NAS, and the lowest workforce
    participation rate.
        But from this tragic epidemic has come an exceptional
    response from communities across my home State. Communities
    have come together to find solutions and they are working to
    get their communities healthy again.
        One of the most shining examples is Lily's Place, a unique
    stand-alone facility that specializes in treating newborns
    suffering from NAS in a clinically appropriate setting. I was
    proud to have worked with two NICU nurses to start Lily's Place
    after they had seen a dramatic rise in newborns with NAS at the
    local hospital.
        Lily's Place has brought national attention to West
    Virginia solutions, being featured in a number of news stories.
    Just yesterday, First Lady, Melania Trump, visited Lily's Place
    in West Virginia to talk with caregivers helping the most
    vulnerable in our society, newborns suffering from NAS.
        Lily's Place provides a perfect environment for newborns
    suffering from NAS, with a low lit, low stimulus environment
    with doctors and nurses providing care. Lily's Place has become
    a model for its ability to treat newborns, and Lily's Place
    includes the mothers and families in the healing process.
        Last year, with the tireless work of the Energy and
    Commerce Committee, Congress passed and the President signed
    the Comprehensive Addiction and Recovery Act or CARA. I was
    honored to have my legislation, the Nurturing and Supporting
    Healthy Babies Act included in the package of bills. This
    legislation required the GAO to take a close look at the
    different care models for NAS and how NAS is covered by
    Medicaid. I thank the members of this committee for working
    with me to further our understanding of how best to take care
    of newborns with NAS.
        The GAO report released last week, had important
    information and a number of key findings in it. Part of what we
    have learned from the GAO report is that nonhospital settings
    are sometimes a better alternative to the NICU for the care
    that NAS newborns need. The report identified and took a close
    look at different care models and how the best practices at
    nonhospital settings can actually reduce costs of care.
        I have sponsored legislation, the CRIB Act, with
    Congressman Mike Turner which makes sure that these nonhospital
    settings are recognized by Medicaid to remove this barrier to
    care for NAS newborns. This legislation would clear the
    confusion at CMS on how to certify these facilities and as to
    what a nonhospital NAS treatment center is.
        The GAO report also highlighted that the Department of
    Health and Human Services has a number of recommendations they
    developed but HHS does not have a clear strategy or timeline
    for implementing these recommendations. I am working on
    legislation to make sure HHS develops a clear timeline and
    begins implementing a number of these recommendations. This
    legislation will give the needed push to HHS so we can help the
    newborns that are most impacted by the opioid epidemic start
    their lives happy and healthy.
        We have a unique opportunity to continue the strong
    bipartisan work on addressing the opioid epidemic and these two
    pieces of legislation can continue this effort. I look forward
    to working with the committee to bring these two pieces of
    legislation to the House floor and send them to the President's
    desk.
        Caring for the most vulnerable impacted by the opioid
    crisis is a truly noble cause and one that we can all come
    together to support.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Dr. Wenstrup, you are recognized for 3 minutes, please.

        STATEMENT OF HON. BRAD R. WENSTRUP, A REPRESENTATIVE IN
                    CONGRESS FROM THE STATE OF OHIO

        Mr. Wenstrup. Well, thank you, Chairman Burgess and Ranking
    Member Green, for hosting this today, and I mean that
    sincerely. We are hearing a lot of good ideas and it gives us a
    lot of food for thought.
        But the opioid crisis is affecting each and every one of
    our districts across the country. That is very obvious, and I
    appreciate the chance to come and speak today and share with
    you some stories from Ohio's 2nd District.
        My office recently sent a survey to the constituents of our
    district and we asked them to share their stories and
    experiences with the opioid epidemic, and the results are
    heartbreaking, as you might imagine.
        We received hundreds of responses--up to seven pages of
    responses, and I just want to share a couple of those with you.
        One said, ``My brother, unfortunately, became addicted as a
    teenager. He is very lucky, because at 33 years old he's still
    here but he is still fighting every day to stay sober. These
    drugs have no place in our country. They are ruining our youth,
    our future.''
        Another one--a woman said, ``I have four boys and three of
    them are struggling with this addiction. The cost of going to a
    methadone clinic is very difficult. The cost of treatment
    facilities is too expensive. I am going broke trying to get my
    children sober.''
        Clearly, this epidemic is devastating for southern Ohio as
    it is across the country. In one county alone, the overdose
    death rate was 37.5 per 100,000 residents and in another county
    318 residents died of an intentional drug overdose in just--in
    2016.
        This spring, the Columbus Dispatch reported at least 4,149
    Ohioans died from an unintentional drug overdose in 2016 and
    one local newspaper called the overdoses the new normal in that
    county.
        I appreciate what Dr. Marshall had to say earlier. As a
    doctor, I can agree with him on many of the factors that have
    driven so many people into addiction, and I would really like
    for us to talk sometime about prevention, which I think is the
    long-term vision for our country.
        I can tell you as a doctor I had someone come up to me just
    last year and say, ``My friend wanted me to thank you if I met
    you,'' and I said, ``Why is that?`` He said, ``Because she was
    addicted to prescription pain meds, and when she came to you,
    you gave her alternatives, and you didn't give her any.''
        We search for answers. We are all searching for answers.
    One of the sheriffs in my district, he's working hard on the
    solution and he's using prevention because he said, I can't
    incarcerate our way out of this.
        But he did show me what one patient received on Medicaid in
    a year--what one patient in one year received from Medicaid as
    far as narcotics, and I promise you it was more than I
    prescribed in my entire surgical practice in a year.
        And then he showed me what Medicaid paid for it. And so
    while I understand that Medicaid is providing help and care for
    a lot of people, it may be driving the problem as well, because
    as some are getting treatment, many are getting fed and the
    problem is being exacerbated and we need to look at that and
    there needs to be better oversight of how we are handling this.
        This sheriff directs an essay contest, asking local
    students to write an essay about the dangers of opioids and how
    they hope to become the generation to stop the epidemic.
        As I said before, he said he can't incarcerate his way out
    of this. We can't always treat our way out of this. But I hope
    that we take some time in this process for a long-term vision
    of how we can prevent people from ever getting in this
    situation to begin with.
        And with that, I yield back, and I thank you for your time
    and attention today.
        [The prepared statement of Mr. Wenstrup follows:]

                  Prepared statement of Hon. Brad R. Wenstrup

        Thank you, Health Subcommittee Chairman Burgess and Health
    Subcommittee Ranking Member Green, for hosting this Member Day
    today. The opioid crisis is affecting each and every one of our
    districts across the country, so I appreciate the opportunity
    to come and speak to you today, along with my colleagues, and
    share with you some stories from Ohio's 2nd District.
        My office recently sent a survey to the constituents of
    Ohio's 2nd District, asking them to share their stories and
    experiences with the opioid epidemic. The results are
    heartbreaking. We received hundreds of responses--all telling
    the same stories. I wanted to just read aloud a few of them for
    you.
        One woman wrote, ``My brother unfortunately became addicted
    as a teenager. He is a very lucky one at 33 years old he is
    still fighting every day to stay sober. These drugs have no
    place in our country. They are ruining our youth, our future.''
        Another said, ``My daughter is currently in rehab for
    heroin addiction; she's destroyed several relationships with
    various members of our family, I am raising her 18-month-old
    son and she's been in and out of jail for several years and
    she's only 27. She's overdosed at least once that I know about
    and has been physically and emotionally abused by a boyfriend.
    I am terrified that she won't live to see 30 and that her son
    will never know the sweet and caring person she was/is when not
    high.''
        Another constituent shared, ``I have 4 boys and 3 of them
    are struggling with this addiction.the cost of going to a
    methadone clinic is very difficult.the cost of treatment
    facilities is too expensive.I am going broke trying to get my
    children sober.''
        Clearly, this epidemic is devastating for Southern Ohio, as
    it is across the country. In one county in Ohio alone, the
    overdose death rate was 37.5 per 100,000 residents. In another
    county, 318 residents died of an unintentional drug overdose in
    2016. This spring, the Columbus Dispatch reported that at least
    4,149 Ohioans died from unintentional drug overdoses in 2016.
    One local newspaper called the overdoses the ``new normal'' in
    that county.
        As we search for solutions to this crisis, I hope you'll
    keep this in mind: Adams County Sheriff Kimmy Rogers, in my
    district, is working hard on a key part of this solution:
    prevention. He runs an after-school program at a local church
    that teaches young kids about the dangers of drugs and opioids.
    He also runs an essay contest, asking local students to write
    an essay about the dangers of opioids and how they hope to
    become the generation to stop the epidemic. When I asked
    Sherriff Rogers about these programs, he said we can't
    incarcerate our way out of this problem. We can't always treat
    our way out of this. But I hope we take some time in this
    process for a long-term vision of how we can prevent people
    from every getting in this situation to begin with.
        With that, I yield back, and I thank you for your time and
    attention today.

        Mr. Green [presiding]. Thank you.
        The Chair, in absence, is recognizing Congresswoman Clark.

       STATEMENT OF HON. KATHERINE M. CLARK, A REPRESENTATIVE IN
            CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS

        Ms. Clark. Thank you, Ranking Member Green, and thank you
    to you and to Chairman Burgess for holding this Member Day
    today.
        We are all here because we lose 91 Americans a day to the
    opioid epidemic and every one of those 91 deaths affects not
    only the victim but also their loved ones, their workplace, and
    their community.
        Now is the time for us to come together and find solutions
    to end this national health emergency. And with that in mind, I
    would like to speak in favor of four common sense proposals
    that I am leading, each with a great Republican partner, aimed
    at addressing a different aspect of the opioid epidemic.
        The first is the Youth Act, which I introduced with my
    colleague from Indiana, Dr. Bucshon. The opioid epidemic has
    had a tragic impact on our young people. From harmful changes
    in brain and social development to long gaps in education and
    job training, the effects can be profound.
        The Youth Act would expand access to evidence-based
    medication-assisted treatment for adolescents and young adults,
    giving them the best possible chance at recovery.
        The second proposal is the Prescriber Support Act, which I
    introduced with my colleague, Congressman Evan Jenkins.
    Tragically, opioid addiction often begins in the doctor's
    office where patients are often prescribed more medication than
    they need or without being informed about the risks of
    addiction.
        The Prescriber Support Act would establish State-based
    resources for prescribers to consult when making decisions
    about prescribing opioids.
        Third, I recently the Every Prescription Conveyed Securely
    Act with my colleague from Oklahoma, Congressman Mullin. This
    proposal would ensure that all prescriptions for controlled
    substances filled through Medicare Part D would be transmitted
    electronically.
        Electronic transmission would help doctors and pharmacists
    spot patients attempting to doctor shop and it would make
    more--make it more difficult to forge a prescription, all the
    while saving taxpayer dollars.
        Finally, I will soon be introducing a bill with my
    colleague from Kentucky, Congressman Hal Rogers, that will
    create a student loan forgiveness program for professionals who
    enter and stay in the substance use treatment field.
        In my district, I have heard time and time again from
    families and providers that there simply aren't enough
    treatment specialists available to help the growing number of
    Americans struggling with substance use disorder.
        Our bill will help build this critical work force. There is
    no single solution to the opioid crisis. However, these four
    bipartisan solutions can help put us on a path to beating this
    epidemic.
        I thank the chairman and the ranking member for giving us
    this opportunity to have this conversation, and I look forward
    to working together.
        I yield back.
        [The prepared statement of Ms. Clark follows:]

                 Prepared statement of Hon. Katherine M. Clark

        Thank you, Mr. Chairman.
        I'd first like to thank you, Chairman Burgess and Ranking
    Member Green, for holding this Member Day today.
        The opioid epidemic claims the lives of 91 Americans a day.
        Every one of those 91 deaths affects not only the victim
    who has lost their life, but also their loved ones, their
    workplace, and their community.
        Now is the time for us to come together and find solutions
    to end this national health emergency.
        With that in mind, I would like to speak in favor of four
    common-sense proposals that I am leading, each with a great
    Republican partner and aimed at addressing a different aspect
    of the opioid epidemic.
        The first is the YOUTH Act, which I introduced with my
    colleague from Indiana, Dr. Buchson.
        The opioid epidemic has had a tragic impact on our young
    people.
        From harmful changes in brain and social development, to
    long gaps in education and job training-the effects can be
    profound.
        The YOUTH Act would expand access to evidence-based
    medication assisted treatment for adolescents and young adults,
    giving them the best possible chance at recovery.
        The second proposal is the Prescriber Support Act, which I
    introduced with my colleague, Congressman Jenkins.
        Tragically, opioid addiction often begins in a doctor's
    office, where patients are often prescribed more medication
    than they need, or without being informed about the risks of
    addiction.
        The Prescriber Support Act would establish State-based
    resources for prescribers to consult when making decisions
    about prescribing opioids.
        Third, I recently introduced the Every Prescription
    Conveyed Securely Act with my colleague from Oklahoma,
    Congressman Mullin.
        This proposal would ensure that all prescriptions for
    controlled substances filledthrough Medicare part D would be
    transmitted electronically.
        Electronic transmission would help doctors and pharmacists
    spot patients attempting to doctor-shop, and it would make it
    more difficult to forge a prescription-all while saving
    taxpayer dollars.
        Finally, I will soon be introducing a bill with my
    colleague from Kentucky, Congressman Hal Rogers, that will
    create a student loan forgiveness program for professionals who
    enter, and stay, in the substance use treatment field.
        In my district, I have heard time and time again from
    families and providers that there simply aren't enough
    treatment specialists available to help the growing number of
    Americans struggling with substance use disorder.
        Our bill will help build this critical workforce.
        There is no single solution to the opioid crisis.However,
    these four bipartisan solutions can help put us on a path to
    beating this epidemic.
        I thank the chairman and the ranking member for giving us
    the opportunity to have this conversation, and I look forward
    to working together.

        Mr. Burgess [presiding]. Chair thanks the gentlelady.
    Gentlelady yields back.
        The gentlelady from Connecticut, Ms. Esty, is recognized
    for 3 minutes, please.

       STATEMENT OF HON. ELIZABETH H. ESTY, A REPRESENTATIVE IN
                 CONGRESS FROM THE STATE OF CONNECTICUT

        Ms. Esty. Thank you, Mr. Chairman--Chairman Burgess and
    Ranking Member Green. Thank you so much for holding this
    important hearing on the growing opioid epidemic.
        Everywhere I go in Connecticut, I meet people whose
    families have lost loved ones to drug addiction--moms and dads,
    sons and daughters, brothers and sisters. It is an epidemic
    that affects families and communities across the country
    regardless of age, race, gender, socioeconomic status.
        During one of my visits recently to Staywell Oasis--it's an
    addiction treatment center in Waterbury--I met a young woman
    who has been struggling on the streets with addiction.
        She has a new child and she is so grateful to be in a
    program that is allowing her to stay clean and helping her keep
    her child.
        I met a 45-year-old man in the Farrell Treatment Center in
    New Britain who for 20 years has been battling his addiction
    and is finally coming to terms with it and able to hold a
    steady job.
        These are real people, real families, and real lives that
    are affected by this crisis, and the stakes are high. If these
    vital treatment centers are forced to close their doors or if
    we limit access to them, people will die.
        In my home town of Cheshire, a neighbor whose daughter was
    a classmate of one of my children contacted the office. They
    had lost track of their daughter.
        She had been on the streets, addicted to drugs. We were
    able to help them find her. She wouldn't accept the treatment,
    and a week later she was dead.
        That's what it's like now in America. The situation is so
    dire in Connecticut that our chief medical examiner lost its
    accreditation. They cannot keep up with the autopsies.
        We are expecting more than a thousand deaths this year.
    That is the third-highest rate in the country. They literally
    cannot keep up with the autopsies. We need to do something and
    this Congress needs to act.
        I am pleased at our good bipartisan work last year. My bill
    of the Prevent Drug Addiction Act of 2016 was included as part
    of the conference committee in our good bipartisan work to
    ensure that we are addressing the issues of prevention with
    many of my colleagues have addressed here today--both provider
    education on how to prescribe as well as for parents, coaches,
    and others who need to be aware of the risks of prescription
    drugs.
        But there is important--there is important work at stake
    and I do want to say something about the Affordable Care Act.
    We need to protect the funding, which is providing vital access
    for people across America, and we are real risk now as we
    consider that funding and whether the Medicaid access will be
    cut off, which is funding so many of the important programs in
    my State.
        So again, I want to thank this committee for the good work
    and encourage all of our members to come together and help
    address this vital need--this growing epidemic that is
    affecting all Americans.
        Thank you, and I yield back.
        [The prepared statement of Ms. Esty follows:]

                  Prepared statement of Hon. Elizabeth H. Esty

        Mr. Chair, thank you for holding this hearing on the
    growing opioid epidemic.
        This epidemic is literally filling the morgues across our
    country.
        Everywhere I go in Connecticut, I meet people whose
    families have lost loved ones to drug addiction--moms and dads,
    sons and daughters, brothers and sisters.
        It's an epidemic that affects families and communities
    across the country--regardless of age, sex, race, or socio-
    economic status.
        During one of my recent visits to Staywell Oasis, an
    addiction treatment center in Waterbury, I met a young woman
    who has a new baby and is so grateful for the help that the
    program is providing for her.
        She emphasized to me how important Staywell is for her--
    that the it is is keeping her clean and off the streets so that
    she can keep her baby.
        Or there's the 45-year-old man that I met at Farrell
    Treatment Center in New Britain who is getting his 20-year
    battle with opioids under control for the first time.
        These are real people, real families, and real lives that
    are affected by the opioid crisis.
        And the stakes are high.
        If these vital treatment centers are forced to close their
    doors, or if we limit access to them, people will die.
        In my hometown of Cheshire, one of my neighbors came to my
    office pleading for help--they could not find their daughter.
        Their daughter had been battling substance addiction for
    years.
        The family did ultimately find their daughter, but it was
    too late.
        She died weeks later without the care and treatment she so
    desperately needed.
        This is how dire the situation is: In our State, the Office
    of the Chief Medical Examiner actually lost its accreditation
    because it simply could not keep up with the body count, due to
    the sharp rise of drug overdose deaths in Connecticut.
        Connecticut's Chief Medical Examiner projected that
    Connecticut will hit a devastating benchmark this year: More
    than 1,000 people will die from opioid overdoses in our State
    alone before the end of the year.
        The medical examiner's office simply cannot keep up with
    the demand for autopsies on the rising number of people who are
    dying from drug overdoses.
        Congress needs to act, and it needs to act now, to save
    lives.
        Instead of finding ways to hire more medical examiners to
    keep up with the rocketing death toll, Congress needs to work
    together to come up with commonsense solutions to end this
    devastating epidemic.
        Last year, I was proud to help write a landmark, bipartisan
    bill to improve resources for cities and towns to address this
    crisis and to create new consumer and provider education
    campaigns to encourage prevention.
        The funding in this bill was not everything our communities
    need--but it was an important step forward.
        The State Targeted Response to the Opioid Crisis Grant
    program, created by the 21st Century Cures Act, provided $1
    billion over the next 2 years to States to address the opioid
    epidemic.
        These grants help support programs for people struggling
    with addiction at places like the Farrell Treatment Center in
    New Britain, the Staywell Oasis Addiction Treatment Center in
    Waterbury, or the McCall Center for Behavioral Health in
    Torrington, provide life-lines to people struggling with
    addiction.
        At the same time, we must ensure that the millions of
    Americans with substance use disorders who currently get
    treatment through Medicaid expansion are able to continue to
    get the care they need.
        The recent, misguided efforts to repeal the Affordable Care
    Act and defund Medicaid expansion would have cut over $800
    billion from the Medicaid program, removing access to treatment
    for low-income people with mental and substance use disorders.
        I am heartened that you have invited me here today to talk
    about how this devastating epidemic is affecting my district,
    and I am committed to continuing to partner with my colleagues
    in Congress to prevent more lives from being taken by the
    opioid epidemic and to help those suffering from addiction to
    recover and move forward.
        Thank you.

        Mr. Burgess. Chair thanks the gentlelady. The gentlelady
    yields back.
        The Chair recognizes the gentlelady from Utah, Mrs. Love,
    for 3 minutes, please.

      STATEMENT OF HON. MIA B. LOVE, A REPRESENTATIVE IN CONGRESS
                         FROM THE STATE OF UTAH

        Mrs. Love. Thank you, Mr. Chairman, for such--talking about
    such an issue, and I would like to thank the Ranking Member
    Green also for giving us the opportunity to speak about the
    opioid epidemic and crisis.
        Nationwide, the rate of deaths has exploded to over--over
    the last 10 years to now more than 60,000 deaths every year. In
    Utah, the Department of Health says that more people are dying
    from opioid and heroin overdose than ever before.
        Six people die from opioid overdose per year. Alarming
    increases from 2013 to 2015. Utah is seventh-highest for those
    deaths per capita in the United States.
        Here is what hits me the hardest is the innocent children
    that are being affected by the opioid epidemic. In too many
    cases, parents are no longer parents. Their children are
    parenting themselves and the parents are now slaves to their
    addiction.
        This is actually happening in Elk Ridge, Utah, a place
    where--which is just a few minutes away from my home. There is
    a boy who is in 3rd grade who talks about his life with his
    mom, who is addicted, and his stepfather, who is addicted.
        He talks about waking up by himself and getting himself
    ready for school and also getting his brother ready for school
    and his newborn sister. He makes breakfast for them and
    prepares a bottle for his newborn baby, who is his sister.
        He talks about the fact that many times he misses the bus
    when he's going to school because he is taking care of his
    brother and sister and there is no one to take him to school.
        His brother cries, asking for his mom and dad, and he, as a
    3-year-old has to try to explain to his brother why Mom and Dad
    aren't around.
        That's not the end of his story. His newborn sister is
    actually addicted to opioids because his mother took the drugs
    while she was pregnant, and while in the hospital, for fear of
    getting caught, she actually took opioids and would rub it on
    the gums of her baby so that the baby wouldn't show signs of
    withdrawal.
        This is what is happening in America. This story is not
    unique to Utah. It is happening everywhere. The parents are now
    in jail. They were arrested for trying to return stolen
    merchandise at the local Wal-Mart and neglect of their
    children.
        But I have to say that the children's lives aren't better
    now without mom and dad. Their nightmare is just beginning. So
    I feel very strongly about this. At a time where there is so
    much partisan politics, this is an issue where so many of us
    are standing together.
        I believe that American democracy is at its best when two
    people are in a room and talk about what they are for, and here
    we are, in a room talking about what we are for.
        I am so proud that we are actually coming together, but
    coming together is not enough. We actually have to apply some
    of these solutions that we are talking about when it comes to
    the crisis, and I think the opportunity to--I am thankful for
    the opportunity to work on this.
        Thank you, and I yield back.
        [The prepared statement of Mrs. Love follows:]

                     Prepared statement of Hon. Mia B. Love

        I appreciate the opportunity to speak on this epidemic of
    the Opioid Crisis, and I appreciate the efforts of everyone
    here. To fight this public health crisis, we must work
    together. I pledge to do whatever I can to assist in that
    effort, because Utah is being hit especially hard by opioid
    abuse and death.
        I am humbled by the raw fact and statistics regarding this
    in my State:
         The Utah Department of Health says that 24
    individuals die from prescription opioid overdoses every month
    in Utah. A growing number of people are dying from heroin
    overdoses.
         The rate of these deaths has exploded over the
    last 10 years. I would say it's out of control. The National
    institute on Drug Abuse reports that there are more than 60,000
    death per in year in our country from prescription and heroin
    use. Utah is in the top five for those types of death per
    capita.
        I don't like to see anyone suffer and die from the
    miserable cycle of drug dependency and abuse.
        And here's what hits me the hardest: Innocent children are
    being affected by this epidemic.
        In too many cases, parents are no longer parents, they're
    drug addicts. Their children are doing the parenting
    themselves, and for their brothers and sisters.
        I recently learned of a case in Elk Ridge, Utah, which is
    just minutes from my home.
        There, a boy in the 3rd grade told the story of life with
    his mom and stepdad: Waking up by himself, making breakfast and
    dinner for his 2-year-old brother and newborn sister. About
    missing the bus, with no one to take him to school. Of his
    brother crying because his mom and dad weren't there.
        Mom and Dad were on heroin: That's why they weren't there.
        And that's not the end of the story.
        That boy's sister--the newborn baby--was born addicted to
    opioids, because her mother was using while she was pregnant.
    After she was born, to hide the baby's withdrawal symptoms from
    the hospital staff, the parents rubbed crushed opioids on the
    child's gums.
        The parents are now in jail-arrested trying to return
    stolen merchandise for money at the local Wal-Mart. And for
    child abuse and neglect.
        Those kids are just an example of the toll this epidemic is
    taking.
        But there are those in my State that are taking steps to
    deal with it. Utah's Intermountain Healthcare has set a goal to
    reduce opioid prescribing by 40 per cent in its 22 hospitals
    and 180 clinics by the end of next year.
        I applaud this effort, but it's obviously just one piece of
    a larger puzzle.
        We need to put those pieces together for our children, for
    ourselves, and for the future of the United States of America.

        Mr. Burgess. Chair thanks the gentlelady. Gentlelady yields
    back.
        Let me take the New Jersey delegation in seniority, and,
    Mr. Pascrell, I will go to you first for 3 minutes.

       STATEMENT OF HON. BILL PASCRELL, JR., A REPRESENTATIVE IN
                 CONGRESS FROM THE STATE OF NEW JERSEY

        Mr. Pascrell. Thank you, Chairman Burgess, Ranking Member
    Green.
        I don't have to tell you or anyone here that opiate abuse
    and misuse is one of our country's fastest growing problems. It
    is also one of the most vexing problems we face and there are
    no simple solutions.
        Prescription drugs serve a valid medical purpose. But many
    of them carry high risk of addiction and abuse. Many of my
    colleagues have good ideas about steps we can take to address
    opiate abuse and misuse. So I commend you for giving us the
    opportunity to share them.
        Today, I would like to share some information about a
    program that was developed and is in use at my hometown
    hospital, St. Joseph's Regional Medical Center in Paterson, New
    Jersey.
        As the busiest emergency department in the State of New
    Jersey, St. Joe's commitment to reducing abuse can serve, I
    believe, as a model for emergency departments across the State
    an across the country. We need to recognize that emergency
    departments are in a unique position with respect to
    prescription drug abuse.
        On one hand, a component of many of their patients'
    treatment involves acute pain that legitimately needs to be
    addressed. But emergency departments, because of the short-term
    nature of the care they provide, are also more susceptible to
    doctor shopping than many other health settings.
        To prevent addiction, where it often starts with a valid
    prescription in the emergency room, St. Jo's initiated a first-
    of-its-kind Alternatives to Opioids, or ALTO--ALTO program, the
    Alternatives to Opiates.
        This new approach utilizes protocols primarily targeting
    five common conditions. The alternative therapies offered
    through St. Jo's ALTO program include targeted nonopiate
    medications, trigger point injections, nitrous oxide,
    ultrasound-guided nerve blocks to tailor patient pain
    management needs, and avoid opiates whenever possible.
        In the first year of operations, this program decreased
    emergency department opiate prescriptions by more then 50
    percent. The goal is not to eliminate opiates altogether
    because these drugs remain an important part of pain
    management.
        However, the ALTO program reserves their use for severe
    pain, end-of-life pain, surgical conditions. That's it. As a
    result, only about 25 percent of the acute pain patients
    treated with nonopiate protocols since the program's launch,
    eventually needed opiates.
        I believe that the initial successes of this program make
    it very important that we--to have a broader implementation and
    study. I leave this to your discretion.
        That is why Senator Booker and I plan to introduce
    legislation to establish a national demonstration program to
    test pain management protocols that limit the use of opiates in
    hospital-based emergency departments.
        It is my hope that strategies that provide alternatives to
    opiates can become a larger part of the discussion on how to
    combat this--the opiate epidemic and that this committee will
    review and consider my legislation upon its introduction.
        And with that, Mr. Chairman, Mr. Ranking Member, I yield
    back to you.
        [The prepared statement of Mr. Pascrell follows:]

                 Prepared statement of Hon. Bill Pascrell, Jr.

        Chairman Burgess, Ranking Member Green, thank you for
    holding this hearing today. I don't have to tell you or anyone
    here that opioid abuse and misuse is one of our country's
    fastest-growing problems. It is also one of the most vexing
    problems we face; and there are no simple answers. Prescription
    drugs serve a valid medical purpose, but many of them carry a
    high risk of addiction and abuse. Many of my colleagues have
    good ideas about steps we can take to address opioid abuse and
    misuse, so I commend you for giving us the opportunity to share
    them.
        Today, I would like to share some information about a
    program that was developed and is in-use at my hometown
    hospital St. Joseph's Regional Medical Center in Paterson, New
    Jersey. As the busiest emergency department in the State of New
    Jersey, St. Joe's commitment to reducing abuse can serve as a
    model for emergency departments across the State and across the
    country.
        We need to recognize that emergency departments are in a
    unique position with respect to prescription drug abuse. On one
    hand, a component of many of their patients' treatment involves
    acute pain that legitimately needs to be addressed. But
    emergency departments--because of the short-term nature of the
    care they provide--are also more susceptible to doctor shopping
    than many other health care settings.
        To prevent addiction where it often starts--with a valid
    prescription in the emergency room--St. Joe's initiated a
    first-of-its kind Alternatives to Opioids (ALTO) program. This
    new approach utilizes protocols primarily targeting five common
    conditions. The alternative therapies offered through the St.
    Joe's ALTO program include targeted nonopioid medications,
    trigger point injections, nitrous oxide, and ultrasound guided
    nerve blocks to tailor patient pain management needs and avoid
    opioids whenever possible.
        In the first year of operations, the ALTO program decreased
    Emergency Department opioid prescriptions by more than 50
    percent. The goal is not to eliminate opioids altogether,
    because these drugs remain an important part of pain
    management. However, the ALTO program reserves their use for
    severe pain, end of life pain, and surgical conditions. As a
    result, only about 25 percent of the acute pain patients
    treated with nonopioid protocols since the program's launch
    eventually needed opioids.
        I believe that the initial successes of this program make
    it worthy of broader implementation and study. That is why
    Senator Booker and I plan to introduce legislation to establish
    a national demonstration program to test pain management
    protocols that limit the use of opioids in hospital-based
    emergency departments.
        It is my hope that strategies that provide alternatives to
    opioids can become a larger part of the discussion on how to
    combat the opioid epidemic; and that this committee will review
    and consider my legislation upon its introduction.
        Thank you.

        Mr. Burgess. Chair thanks the gentleman. The gentleman
    yields back.
        Mr. MacArthur, you are recognized for 3 minutes, please.

        STATEMENT OF HON. THOMAS MACARTHUR, A REPRESENTATIVE IN
                 CONGRESS FROM THE STATE OF NEW JERSEY

        Mr. MacArthur. Well, I thank the Chairman Burgess and
    Ranking Member Green for hosting this opportunity today for
    those of us not on this committee to share our thoughts.
        We have all seen the numbers. Last year, over 60,000 deaths
    from overdose, opioids involved in the vast majority of those.
        In Ocean County, New Jersey, my home county, we are losing
    somebody every 43 hours. A couple of weeks ago, my county was
    designated a high-intensity drug trafficking area--desperately
    needed, but also disturbing sign of where we are.
        It may be unusual for a member to sit here and promote
    other people's bills, even bills written by the other party.
    But as the Republican cochairman of the bipartisan Heroin Task
    Force, representing over 90 members of both parties, that is
    exactly what I am here to do today.
        As your committee considers legislative next steps to
    pursue, I want to recommend the bipartisan Heroin Task Force's
    legislative agenda for your consideration.
        We are committed to being rigorously bipartisan. We did not
    include any bills in our agenda unless it had bipartisan
    cosponsors and both the Republican and the Democratic cochairs
    agreed to it.
        Five of the bills that were recommended fall within your
    jurisdiction. Representative Tim Walberg's Jessie's Law will
    ensure that doctors have access to a consenting patient's prior
    history of addiction so they can make informed decisions.
        Representative David Joyce's Stop OD Act will increase
    first responders' access to Narcan and synthetic opioid
    testing. Representative Hakeem Jeffries' Synthetic Drug
    Awareness Act requires that we investigate how the synthetic
    opioid crisis is affecting young people specifically.
        Representative Evan Jenkins' CRIB Act will ensure treatment
    for babies with neonatal abstinence syndrome, and
    Representative Brian Fitzpatrick's Road to Recovery Act
    addresses the IMD exclusion, which is one of the primary
    barriers preventing access to substance abuse treatment.
        We are proud of our members' work. I would also note that
    many of our agenda ideas coincide with the White House's Opioid
    Commission's recommendations and I also note the good work
    being done by the Republican Main Street on this same issue.
        On behalf of my Democratic cochair, Representative Annie
    Kuster, our vice chairs, Donald Norcross and Brian Fitzpatrick,
    and our 90-plus members, I urge you to consider these bills.
        We will continue to expand and update our legislative
    agenda as we tackle this critical issue facing our country.
        Thank you, and I yield back.
        [The prepared statement of Mr. MacArthur follows:]

                  Prepared statement of Hon. Thomas MacArthur

        Mr. Chairman, Ranking Member:
        Thank you for the opportunity to testify. We have all seen
    the numbers--drug overdose deaths have increased from 52,000 in
    2015 to an estimated 64,000 last year, with opioids involved in
    the majority of those deaths. In Ocean County, New Jersey--my
    home county--someone dies of an overdose, on average, once
    every 43 hours. So thank you for the committee's work on this
    incredibly important subject.
        It may be unusual for a Member to sit here and promote
    other people's bills, even bills written by the other party,
    but as the Republican cochairman of the Bipartisan Heroin Task
    Force, representing over 90 members of both parties, that is
    exactly what I'm here to do.
        As the committee considers legislative next steps to
    pursue, I want to recommend the Bipartisan Heroin Task Force's
    legislative agenda for your consideration. We are committed to
    being rigorously bipartisan--we did not include a bill on this
    agenda unless it had bipartisan cosponsors and unless the
    bipartisan chairs all agreed to it. Five of these bills fall
    under your jurisdiction:
         Rep. Tim Walberg's Jessie's Law, which would help
    ensure doctors have access to a consenting patient's prior
    history of addiction in order to make fully informed treatment
    decisions.
         Rep. David Joyce's STOP OD Act, which would expand
    efforts to prevent addiction, promote treatment and recovery,
    and increase first responders' access to Naloxone and synthetic
    opioid testing.
         Rep. Hakeem Jeffries' Synthetic Drug Awareness
    Act, which requires that we investigate how the synthetic
    opioid crisis is affecting young people specifically.
         Rep. Evan Jenkin's CRIB Act, which would help
    increase access to treatment for babies with neonatal
    abstinence syndrome (NAS) due to exposure to opioids during
    pregnancy.
         And Rep. Brian Fitzpatrick's Road to Recovery Act,
    which would address the IMD exclusion, which we all recognize
    as one of primary barriers preventing access to substance abuse
    treatment.
        We're proud of our members' work, and I would also note
    that many our agenda's ideas coincide with the White House
    Opioid's Commission's recommendations. I also note the good
    work being done by Republican Main Street on this issue--many
    of the bills they recommend are also on our agenda.
        On behalf of my Democratic cochair, Rep. Annie Kuster, our
    Vice Chairs Donald Norcross and Brian Fitzpatrick, and our 90-
    plus members, I urge you to consider these bills. We'll
    continue to expand and update our legislative agenda as we
    tackle additional critical topics like PDMPs and prescriber
    education, and we stand ready to work with committee staff
    however we can to promote good legislation that addresses all
    aspects of this devastating epidemic.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        Chair recognizes the gentleman from Arizona, Mr.
    O'Halleran, for 3 minutes, please.

    STATEMENT OF HON. TOM O'HALLERAN, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF ARIZONA

        Mr. O'Halleran. Chairman Burgess, Ranking Member Green, and
    members of the committee, thank you for allowing me to come
    before you today to testify on an issue that has had a
    devastating impact on my district.
        I want to, first of all, echo the sentiments of
    Representative MacArthur. I am also on the task force.
        At least two Arizonans die every day from opioid overdoses.
    Last year, deaths due to opioids rose 16 percent from the year
    before.
        As a former law enforcement officer, some of what I see
    today is familiar from my time serving communities--the
    harrowing stories of addiction, the pain family members face
    including child abuse, domestic abuse, and the loss of a loved
    one, and also the relationship to organized crime.
        But I must tell you that what we are seeing today, the
    devastation that opioids have wrought on our communities is far
    more impactful than the drugs I fought to keep off the streets
    when I was a cop.
        Over the summer, I held a round table in my district on
    opioids. I heard from families, first responders, local law
    enforcement, and health care providers.
        I am here today to bring their voices to you as we commit
    to tackling this issue in a bipartisan and comprehensive way.
        As you work to develop policies to combat this epidemic, I
    implore you to consider the impacts to rural communities and to
    tribal communities, which face unique obstacles and barriers to
    treatment, care, and recovery resources.
        According to the CDC, American Indian and Alaska natives
    have the highest death rates from opioids than any other
    community. American Indians and Alaska natives have long faced
    disparities when it comes to resources for mental health care
    and substance abuse.
        That's why funding created by the 21st Century Cures Act,
    in addition to expanded Medicaid coverage in Arizona, have been
    crucial in helping families get the care they need.
        As many of your know, access to crucial healthcare services
    in rural communities and across Indian country can be scarce
    and often requires families to travel long distances.
        Providers in rural America have benefited from expanded
    Medicaid coverage and are now seeing lower rates of uninsured
    patients than before.
        In fact, in States that expanded Medicaid, the share of
    uninsured substance use or mental health disorder
    hospitalizations fell from 20 percent in 2013 to 5 percent in
    2015.
        The increase in coverage has allowed rural providers to
    operate on the thinnest of margins, to help keep their lights
    on and their doors open. If Congress repeals that coverage,
    rural providers will close their doors and patients who need
    the help will face fewer choices.
        We need to give States, local law enforcement, and tribes
    more resources and more flexibility to test what works. But we
    must approach this problem comprehensively and with a robust
    commitment to those we represent.
        I urge your committee to thoughtfully consider these issues
    and how they affect communities across rural and tribal
    communities. Those voices must be heard when it comes to this
    crisis.
        And I thank you, and I yield.
        [The prepared statement of Mr. O'Halleran follows:]

                   Prepared statement of Hon. Tom O'Halleran

        Chairman Walden, Ranking Member Pallone, and members of the
    committee:
        Thank you for allowing me to come before you today to
    testify on an issue that has had a devastating impact in my
    district.
        At least two Arizonans die every day from opioid overdoses.
    Last year, deaths due to opioids rose 16 percent from the year
    before.
        As a former law enforcement officer, some of what I see
    today is familiar from my time serving communities: the
    harrowing stories of addiction, the pain family members face,
    and the relationship to organized crime.
        But I must tell you that what we're seeing today--the
    devastation that opioids have wrought on our communities--is
    far scarier than the drugs I fought to keep off the streets
    when I was a cop.
        Over the summer, I held a roundtable in my district on
    opioids. I heard from families, first responders, local law
    enforcement, and health care providers. I'm here today to bring
    their voices to you as we commit to tackling this issue in a
    bipartisan and comprehensive way.
        As you work to develop policies to combat this epidemic, I
    implore you to consider the impacts to rural communities and to
    tribal communities, which face unique obstacles and barriers to
    treatment, care, and recovery resources.
        According to the CDC, American Indian and Alaska Natives
    have the highest death rates from opioids than any other
    community.
        American Indian and Alaska Natives have long faced
    disparities when it comes to resources for mental health care
    and substance abuse.
        That's why funding created by the 21st Century Cures Act,
    in addition to expanded Medicaid coverage in Arizona have been
    crucial in helping families get the care they need.
        As many of you know, access to critical health care
    services in rural communities and across Indian Country can be
    scarce, and often requires families to travel long distances.
        Providers in rural America have benefitted from expanded
    Medicaid coverage, and are now seeing lower rates of uninsured
    patients than before. In fact, in States that expanded
    Medicaid, the share of uninsured substance use or mental health
    disorder hospitalizations fell from 20 percent in 2013 to about
    5 percent in 2015.
        The increase in coverage has allowed rural providers, who
    operate on the thinnest of margins, to help keep their lights
    on and their doors open. In communities across my district,
    these providers are the backbone of care.
        If Congress repeals that coverage, rural providers will
    close their doors and patients who need help now will face
    fewer choices. We need to work with each other to build on the
    progress we've made, not go backwards.
        We need to give States, local law enforcement, and tribes
    more resources and more flexibility to test what works. But we
    must approach this problem comprehensively, and with a robust
    commitment to those we represent. For too long, care and
    resources have been delivered in silos, and those looking for
    help have had to navigate a patchwork of programs, many of
    which were never created to address the scope of the problems
    we're seeing today.
        I urge your committee to thoughtfully consider these issues
    and how they affect communities across rural and tribal
    communities, whose voices must be heard when it comes to this
    crisis.
        Thank you.

        Mr. Burgess. Gentleman yields back. The Chair thanks the
    gentleman.
        If you wish to be excused, you may do so. But we are all
    anxious to hear what the gentleman from Maine has to share with
    us.
        So, Mr. Poliquin, you are recognized for 3 minutes.

    STATEMENT OF HON. BRUCE POLIQUIN, A REPRESENTATIVE IN CONGRESS
                        FROM THE STATE OF MAINE

        Mr. Poliquin. Thank you, Mr. Chairman, very much and thank
    you, Ranking Member, for the opportunity to be in front of you
    today.
        In our great State of Maine, Mr. Chairman, we have on
    average one person dies every day from a drug overdose. There
    was a recent study that said that six out of 10 families in our
    great State--six out of 10, Mr. Chairman--are impacted directly
    or indirectly by this epidemic, including, I might add, my own
    family.
        Rural Maine has been hard hit. Rural America has been hard
    hit with this epidemic and that is why I joined the bipartisan
    task force to combat the heroin epidemic and that led in part
    to a very comprehensive bill that we all passed in a bipartisan
    way last year, the Comprehensive Addiction Recovery Act, that
    sent about a billion dollars back to our States so they had
    better resources and more flexibility to address this scourge
    on our kids and our family members directly at the--on the
    ground in our--in our respective districts.
        Now, the motto, Mr. Chairman, of the great State of Maine
    is ``Dirigo.`` It means, in Latin, ``I lead.'' And there are a
    bunch of things we have been doing in Maine to help fight this
    epidemic that I think the rest of the country can learn as we
    learn from others.
        We have put in place a prescription monitoring program that
    is very tough and very effective. In particular, it sets very
    strict limits on what opioid--opiates are prescribed.
        It mandates the use of this system by prescribers and if
    you are prescribing opioids in the State of Maine, you must
    check this program--this database--on a regular basis to make
    sure those that are being prescribed should be, in fact, those
    that are receiving the painkillers.
        If folks are coming from out of State or they're paying
    with cash, it also triggers a review of the program to make
    sure that these drugs are falling in the hands of the right
    people.
        Now, I also serve, Mr. Chairman, I might add, on the House
    Veterans Affairs Committee, and along with Mr. Dunn, Ms.
    Tenney, Jodey Arrington from Texas, and Mr. Tonko, we have
    introduced a bill that asks the Veterans Administration
    facilities in the State of Maine, and hopefully around the
    country, to use their local State prescription monitoring
    programs or to interface with those because they're more
    comprehensive. In many cases, they are tougher.
        I would also encourage you, Mr. Chairman and Mr. Ranking
    Member, as you are going down this path to make sure we do
    everything humanly possible to hold those that are
    manufacturing synthetic opioids like fentanyl, hold them
    accountable. These drugs are horrible, they are not expensive
    to manufacture, and they are anywhere from 50 to 100 times more
    potent than heroin and methadone.
        So with that, sir, I appreciate the opportunity to
    participate here. I know that my associates on either side of
    me have a lot to say. But we've done a lot in Maine, and we are
    very proud of it. But we've got a lot more work to do.
        Thank you, sir.
        [The prepared statement of Mr. Poliquin follows:]

                   Prepared statement of Hon. Bruce Poliquin

        Good afternoon, Chairman Burgess, Ranking Member Green and
    members of the subcommittee. I appreciate the opportunity to
    discuss an issue that touches so many Maine families, including
    my own. An increasing number of Mainers are severely affected
    by drug abuse and addiction. In 2015 alone, 269 Mainers died of
    an opioid overdose. It is clear that we must work to solve this
    serious problem impacting Maine and the rest of our Nation.
        I am a founding member of the Bipartisan Task Force to
    Combat the Heroin Epidemic. Since 2015, we have been a force
    for action, addressing the epidemic by learning from
    professionals in communities impacted by addiction. We have
    welcomed panelists, who have been able to provide valuable,
    real-life insight to help us work toward common-sense
    solutions. The Task Force helped bring awareness to the
    Nation's need to address drug prevention and treatment, as well
    as to ensure that law enforcement officers have the tools
    necessary to fight this epidemic. I'm pleased that Congress
    responded to this crisis by passing the Comprehensive Addiction
    and Recovery Act.
        This legislation was a crucial step towards recovery for
    our families, friends, and communities, but was just one of
    many steps on the long road ahead. I am here today to discuss
    the importance of advancements in tools for prevention,
    enhanced reforms for bad actors, and our role in fostering
    interagency communication.
        In order to help ensure that patients are not abusing
    prescriptions, Maine has set strict limits on opioid
    prescriptions. In addition to mandating the use of the
    prescription monitoring program, Maine requires prescribers to
    check the program when first prescribing, and every 90 days
    thereafter, requires dispensers to check the respective State's
    program when dispensing to an out-of-State resident and for a
    prescription written by an out-of-State provider. The dispenser
    also needs to check the program if an individual is paying with
    cash or if the person has not had a prescription for an opioid
    medication in the previous 12 months.
        These additional requirements create significant barriers
    to those attempting to abuse the system. Looking forward, it is
    crucial that we work toward the sharing of data between States
    to further deter system abuse and decrease the number of
    patients who will develop an addiction. As a member of the
    House Veterans Affairs Committee, I, along with Rep. Dunn, Rep.
    Tenney, Rep. Arrington and Rep. Tonko, have introduced the
    Veterans Opioid Abuse Prevention Act to ensure that providers
    from the Department of Veterans Affairs also use the program
    when prescribing controlled substances.
        There will always be bad actors, but it is our
    responsibility to remain steadfast in our work to close any
    loopholes for abuse. As the Energy and Commerce Committee
    continues to examine synthetic opioids, it is crucial that law
    enforcement receive the resources they need to hold accountable
    those who illegally manufacture fentanyl. The death rate for
    synthetic opioids other than methadone has significantly
    increased in Maine. The Task Force has discussed how local law
    enforcement can collaborate with the Federal and State
    governments as well as public health agencies to combat the use
    of synthetic opioids. Furthermore, we have discussed how the
    investigative arm of the Department of Homeland Security works
    with Federal, State, and local law enforcement to investigate
    criminal organizations that are participating in the
    trafficking of synthetic drugs. I hope to continue these
    discussions as we review and modify best practices.
        As we continue to work towards addressing today's crisis
    and future threats, I would like to thank you for your time and
    attention to these critical issues.

        Mr. Burgess. Chair thanks the gentleman.
        Would the gentleman entertain one question on your
    prescription drug monitoring program?
        Mr. Poliquin. Yes, sir.
        Mr. Burgess. Do you provide feedback to the prescribing
    doctor: This is the list of patients we have for you that you
    have prescribed? Is this a two-way street?
        Mr. Poliquin. It is, but the system is quite accurate, Mr.
    Chairman, such that the prescriber can see that data online.
        Mr. Burgess. Very well.
        Representative Rouzer, you are recognized for 3 minutes,
    please.

     STATEMENT OF HON. DAVID ROUZER, A REPRESENTATIVE IN CONGRESS
                    FROM THE STATE OF NORTH CAROLINA

        Mr. Rouzer. Thank you, Mr. Chairman, and the other members
    of this distinguished committee for your work to bring
    awareness to this opioid epidemic as well as your work to bring
    forward solutions to help address it.
        I am particularly grateful for your willingness to allow
    members who do not serve on this committee the opportunity to
    share how our districts have been impacted by this scourge.
        Opioid addiction has become a growing problem throughout
    North Carolina and particularly in the southeastern part of the
    State, home of the 7th Congressional District, which I have the
    privilege to represent.
        It is a growing and significant challenge for our
    communities, parents, law enforcement, local health
    departments, treatment facilities, and schools, to name just a
    few.
        This epidemic is so rampant, in fact, it would not be a
    stretch to say that if a family doesn't have a relative
    suffering from this addiction, they know a friend or a family
    who does.
        Perhaps most alarming to me are the reports out of my
    district about Narcan parties. That's right, Narcan parties.
    These are parties where teens and others go intending to get as
    high as possible with the expectation that they will be brought
    back to life by an injection of Narcan if needed.
        I also hear from members of the law enforcement community
    that they are administering Narcan to the very same individuals
    on a regular, even weekly, basis.
        Now, if this isn't a sobering fact of how this addiction is
    destroying lives, I don't know what is.
        In 2015, there were more than 1,100 opioid-related deaths
    across the State of North Carolina. The three counties most
    impacted by the opioid epidemic in the 7th Congressional
    District are Brunswick, New Hanover, and Pender counties.
        In 2015, there were 24 deaths in Brunswick County, 45
    deaths in New Hanover, and 14 deaths in Pender County. Now,
    I've met with and heard from parents who have lost a child to
    an overdose, law enforcement officers who are struggling daily
    to prevent this epidemic from further penetrating into our
    communities, and individuals working at treatment facilities
    who do not have enough resources or beds to keep up with the
    demand.
        As with every complex problem, there is no silver bullet
    answer to this epidemic, unfortunately. However, it's my belief
    that Congress can play a significant role by facilitating
    collaboration among the very best and brightest to bring
    solutions forward that will enable the country to turn the
    tables on this scourge.
        In the 7th Congressional District, we are fortunate to have
    many bright and committed individuals who have been working
    diligently on this issue for some time, many of whom serve on
    my Law Enforcement and Health Care Advisory Committees.
        And each of them, Mr. Chairman, stand ready to assist this
    committee and Congress as we work to address this problem in a
    comprehensive and effective way.
        Thank you again, Mr. Chairman, for the opportunity to
    testify today. I yield back.
        [The prepared statement of Mr. Rouzer follows:]

                    Prepared statement of Hon. David Rouzer

        Thank you, Mr. Chairman, and the other members of this
    distinguished committee for your work to bring awareness to the
    opioid epidemic as well as your work to bring forward solutions
    to help address it. I am particularly grateful for your
    willingness to allow members who do not serve on this committee
    the opportunity to share how our districts have been impacted
    by this scourge.
        Opioid addiction has become a growing problem throughout
    North Carolina, and particularly in the southeastern part of
    the State, home of the 7th Congressional District, which I have
    the privilege to represent. It is a growing and significant
    challenge for our communities, parents, law enforcement, local
    health departments, treatment facilities, and schools to name
    just a few. This epidemic is so rampant, in fact, it would not
    be a stretch to say that if a family doesn't have a relative
    suffering from this addiction, they know a friend or family who
    does.
        Perhaps most alarming are the reports out of my district
    about Narcan parties. That's right--Narcan parties. These are
    parties where teens and others go intending to get as high as
    possible with the expectation that they will be brought back to
    life by an injection of Narcan, if needed. I also hear from
    members of the law enforcement community about how they
    administer Narcan to the same individuals on a regular and
    repeated basis. If this isn't a sobering fact of how this
    addiction is destroying lives, I don't know what is.
        In 2015, there were more than 1,100 opioid related deaths
    across the State of North Carolina.
        The three counties most impacted by the opioid epidemic in
    the 7th District are Brunswick, New Hanover, and Pender
    counties. In 2015, there were 24 deaths in Brunswick County, 45
    deaths in New Hanover County and 14 deaths in Pender County.
        I've met with and heard from parents who have lost a child
    to an overdose, law enforcement officers who are struggling
    daily to prevent this epidemic from further penetrating into
    our communities, and individuals working at treatment
    facilities who do not have enough resources and beds to keep up
    with the demand.
        There is no silver-bullet answer to this epidemic,
    unfortunately. However, Congress can play a significant role by
    facilitating collaboration among the very best and brightest to
    bring solutions forward that will enable the country to turn
    the tables on this growing epidemic.
        In the 7th Congressional District, we are fortunate to have
    many bright and committed individuals who have been working
    diligently on this issue--many of whom serve on my law
    enforcement and health care advisory committees. Each of them
    stands ready to assist this committee and Congress as we work
    to address this problem in a comprehensive and effective way.
        Thank you again, Mr. Chairman, for allowing us this
    opportunity to testify today.

        Mr. Burgess. Chair thanks the gentleman. The gentleman
    yields back.
        Chair recognizes the gentleman from Iowa, Mr. Young, for 3
    minutes, please.

      STATEMENT OF HON. DAVID YOUNG, A REPRESENTATIVE IN CONGRESS
                         FROM THE STATE OF IOWA

        Mr. Young. Thank you, Mr. Chairman and Ranking Member. I
    would like to thank the committee for holding this hearing and
    I just really want to tell a story.
        I want to highlight the actions the community of
    Bridgewater, Iowa has undertaken in the last year to take back
    their town. Bridgewater, a small town of about 200 people in
    Adair County in southwest Iowa, is facing a problem with
    opioids and a range of other drugs.
        As drug use in the area slowly started to rise in the
    community, which relies on the county sheriff's office to keep
    them safe, the residents were unable but not unwilling to stop
    the influx of drugs into their town.
        Residents of Bridgewater started to see cars coming into
    their town with out-of-State license plates and from counties
    across the State as the cars came, so did the crime.
        Residents and law enforcement noticed an uptick of crimes,
    theft, and vandalism, which traced back to drug users and
    dealers coming to town. Empty houses turned into drug houses
    powered by gas and generators, which led to more than four
    houses burning to the ground.
        Last spring, the residents were fed up as they saw the town
    they were raised up in slipping away. They decided to take
    action. Concerned residents met in the basement of a church to
    find a way to save their town. This is when they decided to
    take back Bridgewater.
        Residents formed a nonprofit group to fight the drug crisis
    together. As word spread, media outlets across the State came
    to the small town to shine a light on one of the many
    communities suffering in this 3rd District.
        I visited Bridgewater in April to meet with the residents
    in that same church basement as they began their mission to
    make sure that their town was safe again. I studied their
    faces, listened intently, and their mission is my mission.
        They started to hold forums with drug counsellors, law
    enforcement, State and local legislators and other individuals
    offering help. As residents started to clean up their town,
    they were met with hostility and retaliation from drug dealers
    and users.
        Leaders of the take back Bridgewater movement were run off
    the road, swerved at by those who wanted to protect the status
    quo. A number of other incidents occurred but the residents
    pressed on. The citizens of Bridgewater will not surrender.
        As neighboring communities saw what the residents of
    Bridgewater were doing, they wanted to do something in their
    communities. Leaders from towns across southwest Iowa often
    discussed strategies together to protect their neighbors. That
    is what Iowa is all about--neighbors helping neighbors,
    communities helping communities.
        Just last night, residents of Bridgewater gathered in the
    basement of that very same church to kick off a fundraiser for
    their nonprofit. They will be going throughout southwest Iowa
    to sell Christmas trees to adorn the doors of homes throughout
    the region.
        Residents will use these funds to take back the community.
    Bridgewater will not turn a blind eye to opioids and drugs in
    their community. And, of course, we mustn't forget the human
    tragedy of addiction and desperation. This epidemic is
    enslaving and killing our sons and daughters, our mothers and
    fathers.
        As the Federal Government addresses this issue, it is my
    hope we use Bridgewater as an example that local communities
    can have the largest impact if we partner with them and helping
    them to have those tools they need to be successful.
        A one-size-fits-all program will not save as many lives as
    a solution tailored to one community which has the buy-in of
    its residents.
        Take back Bridgewater is not just a slogan. It is an action
    plan, it is reality, and it is happening, and it is not just
    happening in Bridgewater. It is happening all around the
    country.
        Thank you for holding this hearing.
        [The prepared statement of Mr. Young follows:]

                     Prepared statement of Hon. David Young

        Mr. Chairman, I would like to thank the committee for
    holding this hearing.
        I want to highlight the actions the community of
    Bridgewater, Iowa has undertaken in the last year to take back
    their town.
        Bridgewater, a small town of around 200 in the heart of
    Adair County in southwest Iowa, is facing a problem with
    opioids and a range of other drugs.
        As drug use in the area slowly started to rise in the
    community, which relies on the county sheriff's office to keep
    them safe, the residents were unable, but not unwilling, to
    stop the influx of drugs into their town.
        Residents of Bridgewater started to see cars coming into
    town with out of State license plates, and from counties across
    the State.
        As the cars came, so did the crime.
        Residents and law enforcement noticed an uptick of crimes--
    theft and vandalism--which traced back to drug users and
    dealers coming to town.
        Empty houses turned into drug houses powered by gas and
    generators, which led to more than four houses burning to the
    ground.
        Last spring, residents were fed up as they saw the town
    they were raised in slipping away. They decided to take action.
        Concerned residents met in the basement of a church to find
    a way to save their town. This is when they decided to take
    back Bridgewater.
        Residents formed a nonprofit to fight the drug crisis
    together. As word spread, media outlets across the State came
    to this small town to shine a light on one of many communities
    suffering in the 3rd District.
        I visited Bridgewater in April to meet with residents in
    that church basement as they began their mission to make their
    town safe again. I studied their faces. I listened intently.
    And their mission is my mission.
        They started to hold forums with drug counselors, law
    enforcement, State and local legislators, and other individuals
    offering help.
        As residents started to clean up their town they were met
    with hostility and retaliation from drug dealers and users.
        Leaders of the Take Back Bridgewater movement were run off
    the road, swerved at by those who wanted to protect the status
    quo. A number of other incidents occurred, but the residents
    pressed on. The citizens of Bridgewater will not surrender.
        As neighboring communities saw what the residents of
    Bridgewater were doing, they wanted to do the something in
    their communities. Leaders from towns across southwest Iowa
    often discuss strategies together to protect their neighbors.
        That is what Iowa is all about: neighbors helping
    neighbors, communities helping communities.
        Just last night, residents of Bridgewater gathered in the
    basement of that very same church to kick off a fundraiser for
    their nonprofit. They will be going throughout southwest Iowa
    to sell Christmas wreaths to adorn the doors of homes
    throughout the region.
        Residents will use the funds to take back their community.
    Bridgewater will not turn a blind eye to opioids and drugs in
    their community. And of course we must not forget this this
    human tragedy of addiction and desperation. This epidemic is
    enslaving and killing our sons and daughters; mothers and
    fathers.
        As the Federal Government addresses this issue, it is my
    hope we use Bridgewater as an example local communities can
    have the largest impact if we partner with them and helping
    with the tools they need to be successful. A one-size-fits-all
    program will not save as many lives as a solution tailored to
    each community which has the buy-in of its residents.
        Take Back Bridgewater is not just a slogan. It's an action
    plan. It's a reality. And it's happening. And it's not just
    happening in Bridgewater, it's happening all around the
    country.
        Thank you again for the opportunity to join you today.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        The gentleman from Oregon, Mr. Blumenauer, recognized for 3
    minutes.

    STATEMENT OF HON. EARL BLUMENAUER, A REPRESENTATIVE IN CONGRESS
                        FROM THE STATE OF OREGON

        Mr. Blumenauer. Thank you, Mr. Chairman. I appreciate the
    focus on the opioid crisis that grips every community to some
    degree and affects every State, especially critical for our
    veterans who are twice as likely to die from accidental
    overdoses.
        As we are slowly acknowledging the depths of the opioid
    crisis, which is good, we seldom acknowledge one of the
    simplest most effective solutions--medical marijuana. Cannabis.
    Now available in 28 States, largely driven by the voters, not
    the politicians, most recently in Florida, where their voters
    approved it by over 70 percent.
        I have distributed some information here entitled, ``The
    Physician Guide to Cannabis-Assisted Opioid Reduction'' On the
    back are the citations for each of the points that are on this
    chart referencing cannabis reducing opioid overdose mortality,
    how cannabis reduces opioid consumption, how cannabis can
    prevent dose escalation and the development of opioid
    tolerance. Cannabis alone or in combination with opioids could
    be a viable first line analgesic.
        Mr. Chairman, we don't talk much about this, although on
    the floor of the House repeatedly over the last 3 years
    Congress has been moving in this direction and voted last
    Congress to have the Veterans Administration be able to work
    with veterans in States where medical marijuana is legal.
        But I focus on just one simple item, not the facts, which I
    hope this committee would look at. But there is one piece of
    legislation that I have introduced with Dr. Andy Harris,
    somebody who doesn't agree with me about the efficacy of
    medical marijuana but he strongly agrees with me that there is
    no longer any reason for the Federal Government to interfere
    with research to be able to prove it.
        The Federal Government as a stranglehold on this research.
    We have bipartisan legislation, 3391, which would break that
    stranglehold and be able to have robust research to resolve
    these questions so there would no longer be any doubt.
        This is the cheapest, most effective way to be able to stop
    the crisis. Where people have access to medical marijuana,
    there are fewer overdoses and people opt for it dealing with
    chronic pain.
        I would appreciate the subcommittee looking at this issue
    as your time permits. Thank you, Mr. Chairman, Ranking Member.
        [The prepared statement of Mr. Blumenauer follows:]

                   Prepared statement of Hon. Earl Blumenauer

        As this hearing today highlights, opioids have wreaked
    havoc on our country, killing people and devastating families.
    I am here today to offer an alternative treatment for pain,
    PTSD, and a number of other health problems-medical cannabis.
        Despite the fact that more than 95 percent of Americans
    live in States that have legalized some form of medical
    cannabis, Federal policy is blocking biomedical research of
    marijuana.
        This is outrageous!
        We owe it to patients and their families to allow for the
    research physicians need to understand marijuana's benefits and
    risks and determine proper use and dosage. The Federal
    Government should get out of the way to allow for this long
    overdue research.
        Unfortunately, States cannot address this research gag on
    their own. Congress must act to allow for the research of
    marijuana-which I stipulate would be a safer, less addictive
    alternative than opioids for some health problems.
        And, it's not just me who thinks this. I have veterans
    banging down my door seeking alternatives to opioids. Many
    veterans are in an untenable situation-- Untreated chronic pain
    can increase the risk of suicide, but poorly managed opioid
    regimens can also be fatal. The fact that veterans are TWICE as
    likely to die from accidental opioid overdoses than their
    civilian counterparts to get Congress off the dime.
        Dr. Andy Harris--a well-known marijuana prohibitionist--and
    I--the Member of Congress from Portlandia--have teamed up to
    introduce the Medical Marijuana Research Act. This bill would
    create a pathway for qualified researchers to conduct research
    using marijuana. Senators Hatch and Schatz have a similar bill
    on the Senate side.
        I ask that this committee hold a hearing on the bill as
    patients desperately need a safer, less addictive alternative
    to opioids.

        Mr. Burgess. The Chair thanks the gentleman. Gentleman
    yields back.
        Chair recognizes the gentlelady from Georgia, Mrs. Handel,
    for 3 minutes, please.

    STATEMENT OF HON. KAREN C. HANDEL, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF GEORGIA

        Mrs. Handel. Thank you, Mr. Chairman, and thank you as well
    for holding this hearing.
        The opioid crisis has hit the suburban Atlanta counties of
    Fulton, Cobb, and DeKalb as hard as, frankly, anywhere in the
    country, from prescription painkillers to synthetic drugs to
    heroin.
        In 2016, 72.3 percent of all drug-related fatalities in
    Cobb County were caused by opioids and that was an increase
    from 16.8 percent just the year before.
        In 2015, the Cobb County narcotics team seized more than--
    more heroin than in the previous 20 years combined. Meanwhile,
    in Fulton County, the medical examiner's office recorded a
    total of 77 heroin deaths in 2014. That is compared to just
    four such deaths in 2010.
        Behind these statistics, though, are hurting devastated
    families--families that are being torn apart by addiction,
    facing financial ruin in their desperate effort to try anything
    to make things right, or worse, losing a loved one to a drug
    overdose or suicide.
        The opioid crisis, as we've heard, is indeed a complex one.
    It is an incredibly sensitive issue, particularly for
    communities that have long felt immune to fatal substance abuse
    problems.
        Still, communities, through churches, law enforcement,
    nonprofits, with the support of local, State, and Federal
    government are coming together to take action.
        This year in the city of Alpharetta, they created a new
    program designed to reduce painkiller abuse across the county.
    With the help of the Rotary Club in Alpharetta, the city
    purchased special boxes that were--are used to collect unused
    and unwanted prescription medication and locating those at
    police headquarters and fire stations throughout the county.
        While the boxes cost about a thousand dollars each, they
    are designed and constructed specifically to prevent anyone
    from stealing the drugs inside. This is--may seem a small
    measure, but it is making an impact by providing a safe secure
    disposal point.
        In the city of Johns Creek, the Hub Community Resource
    Center is acting as a lifeline for those seeking drug abuse and
    mental illness attention.
        Ultimately, the incarceration of addicts, though, should
    not be seen as some kind of victory or solution. Instead, we
    have to continue to look for the root causes.
        As the district attorney in Cobb County said, we are not
    going to be able to arrest our way out of this epidemic. The
    road to recovery must be lined with treatment options.
        So further, nonopioid and nonpharmacalogical treatments for
    therapies do exist. Atlanta's Emory University recognized Pain
    Awareness Month in September by educating our community about
    these alternatives.
        We also need to do a better job of data sharing important
    information that exists at the local, State, and Federal level.
    I stand ready to help you in any way.
        Thank you, Mr. Chairman, for this opportunity.
        [The prepared statement of Mrs. Handel follows:]

                   Prepared statement of Hon. Karen C. Handel

        The opioid crisis has hit the suburban Atlanta counties of
    Fulton, Cobb & Dekalb as hard as anywhere in the country.
        In 2016, 72.3 percent of all drug-related fatalities in
    Cobb County were caused by opioids, up from 64.8 percent just 1
    year before. And in 2015, the Cobb County Narcotics team seized
    more heroin than in the previous 20 years--combined.
        Meanwhile, in neighboring Fulton County, the Medical
    Examiner's Office recorded a total of 77 heroin deaths in 2014,
    compared to just four in 2010.
        Behind these statistics are hurting families--families that
    are being torn apart by addiction, facing financial ruin in
    their effort to try anything to make things right, or worse,
    losing a loved one to overdose or suicide.
        Our community's--our Nation's--opioid crisis is a complex
    issue, and it's not going to be solved with any single
    proposal. Admitting there is a problem is the first step,
    however.
        This is an uncomfortable, sensitive issue, particularly in
    communities that have long felt immune to fatal substance abuse
    problems. Still, communities--through churches, law
    enforcement, non profits--are coming together to take action.
        This year, the North Fulton city of Alpharetta created a
    new program designed to reduce painkiller abuse across the
    county. With the help of Alpharetta's Rotary Club, the city
    purchased boxes that will collect unused and unwanted
    prescription medications at its police headquarters and fire
    stations.
        The boxes cost about $1,000 each and are designed and
    constructed to prevent anyone from stealing the drugs inside.
        It may seem a small measure, but it is making an impact by
    providing a safe, secure disposal point.
        In the city of Johns Creek, the Hub Community Resource
    Center acts as a lifeline for those seeking drug abuse and
    mental illness attention. Centers like these help people
    suffering from addiction and prevent others from succumbing to
    the same fate in the future.
        Ultimately, the incarceration of addicts should not be seen
    as some kind of victory or solution. Instead, we must look at
    the root causes, most effective potential solutions, and--most
    importantly--we must work towards finding ways for those
    affected by opioid addiction to recover to lead healthy,
    productive lives.
        As Cobb County District Attorney Vic Reynolds said, ``We
    cannot arrest our way out of this epidemic. The road to
    recovery must be lined with treatment options.''
        Further, nonopioid and nonpharmacological treatments or
    therapies for pain do exist. Studies show that these
    alternative therapies can be just as beneficial or better than
    prescription pain medications, but without the side effects of
    overuse and abuse.
        Atlanta's Emory University recognized Pain Awareness Month
    in September by educating the community about pain relief
    alternatives to prescription medications.
        As the opioid epidemic spreads, we need data and
    alternatives to medications now more than ever.
        Finally, I want to specifically commend two legislators in
    my home State of Georgia--State Senator Renee Untermann and
    State Representative Sharon Cooper--each of whom have been
    leading the efforts on opioid addiction prevention from the
    State capitol. Senator Unterman is the chairman of the
    Committee on Health and Human Services and sponsor of SB81,
    legislation focused on Naloxone availability and electronic
    reporting of controlled substances in Georgia.
        We can do better than this crisis we're facing across the
    country, and creative options like those we're seeing
    throughout the 6th District of Georgia are all part of the
    national effort. Our local, State and Federal law enforcement,
    healthcare groups, drug enforcement agencies and elected
    leaders must continue to work together. The lives of tens of
    thousands of Americans are literally depending on it.

        Mr. Burgess. The Chair thanks the gentlelady. Gentlelady
    yields back.
        Recognize Representative Crist from Florida, 3 minutes,
    please.

     STATEMENT OF HON. CHARLIE CRIST, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF FLORIDA

        Mr. Crist. I would like to thank Chairman Burgess and
    Ranking Member Green for providing us this opportunity for
    Members to share how the opioid crisis is affecting their
    constituents, including my neighbors in Pinellas County,
    Florida.
        The statistics for opioid deaths and disorders are
    shocking. Our society's use of opioids has truly become an
    epidemic. Last year, 11.8 million Americans age 12 or older
    misused opioids, including nearly 900,000 children age 12 to
    17.
        Over 50 percent of the people with both substance abuse and
    a mental health disorder do not receive treatment for either
    issue. Tragically, my home State of Florida was the
    prescription drug abuse capital of the United States in the
    last decade.
        They were known as pills mills and prescribed massive
    amounts of otherwise legal narcotics which were then
    distributed into our neighbourhoods, schools, communities, and
    throughout the country.
        When I was Governor, we went after pill mills and put them
    out of business. While Florida may have won the battle against
    these pill mills, our country is losing the war on opioid abuse
    and its addiction.
        We are ignoring mental health, under funding addiction
    treatment, sidestepping what the science tells us is the best
    way to fight the addiction, and now the scope of the crisis has
    broadened beyond prescription drugs into heroin and even
    fentanyl.
        My home of Pinellas County was no exception. Last year, we
    saw a string of deaths from Xanax mixed with fentanyl. In 2015,
    heroin, fentanyl, and oxycodone were responsible for over 3,800
    deaths in Florida alone.
        It is a tragedy, it is an epidemic, and the need for action
    is immediate. I saw the devastation firsthand recently when I
    visited the nonprofit Operation PAR in my district just a few
    months ago.
        I heard directly from those in recovery being helped by
    their innovative, more holistic approach.
        If we are going to combat this problem, we can't
    concentrate on law enforcement alone. Florida should serve as
    an example to the rest of the country that only going after
    suppliers is insufficient.
        Let us be clear. The people who misuse opioids aren't the
    worst of the worst. They are our neighbors, our friends,
    parents, and children who are desperately in need of help.
        They often suffer in silence and isolation because of the
    stigma and shame surrounding drug abuse. Unfortunately, America
    learned this lesson the hard way, treating the crack epidemic
    as simply a law enforcement exercise.
        We can't combat our opioid crisis without investing in new
    treatment options, long-term mental health, and substance abuse
    recovery resources, and the men and women on the ground working
    in nonprofits and Government, collaborating with first
    responders and law enforcement to help those in need in all of
    our communities.
        This includes funding for the substance abuse mental health
    service and the National Institutes of Health, which provides
    the research and innovative treatments not often permitted
    using traditional funding.
        This funding provides grants including in Pinellas County
    for innovative local solutions for treating mental health and
    substance abuse disorders, like what is happening at Operation
    PAR and Bent Not Broken organization.
        This includes funding overdose reversal. We will lose this
    fight without Naloxone. Americans will die unnecessarily, and
    because Florida did not expand Medicaid, the funding for these
    organizations is even more vital and something I hope your
    committee continues to prioritize in this ongoing battle.
        Thank you again for this opportunity to share how my home
    in Pinellas County is combatting this epidemic.
        Thank you, Mr. Chairman, and committee.
        [The prepared statement of Mr. Crist follows:]

                    Prepared statement of Hon. Charlie Crist

        I'd like to thank Chairman Burgess and Ranking Member Green
    for providing us this opportunity for Members to share how the
    opioid crisis is affecting their constituents, including my
    neighbors in Pinellas County, Florida.
        The statistics for opioid deaths and disorders are
    shocking. Our society's use of opioids has truly become an
    epidemic. Last year, 11.8 million Americans aged 12 or older
    misused opioids, including nearly 900,000 children aged 12-17.
    Over 50 percent of the people with both substance abuse and a
    mental health disorder do not receive treatment for either
    issue.
        Tragically, my home State of Florida was the prescription
    drug abuse capital of the United States in the last decade.
    They were known as ``pill mills'' and prescribed massive
    amounts of otherwise legal narcotics, which were then
    distributed into our neighborhoods, schools, communities, and
    throughout the country. When I was Governor, we went after
    ``pill mills'' and put them out of business.
        While Florida may have won the battle against these ``pill
    mills'', our country is losing the war on opioid abuse and its
    addiction. We're ignoring mental health, underfunding addiction
    treatment, side-stepping what the science tells us is the best
    way to fight addiction. And now the scope of the crisis has
    broadened beyond prescription drugs--into heroin and even
    fentanyl. My home of Pinellas County was no exception. Last
    year, we saw a string of deaths from Xanax mixed with fentanyl.
    In 2015, heroin, fentanyl, and oxycodone were responsible for
    over 3,800 deaths in Florida alone. It is a tragedy. It is an
    epidemic. And the need for action is immediate. I saw the
    devastation firsthand recently when I visited the nonprofit
    ``Operation PAR'' in my district just a few months ago. I heard
    directly from those in recovery, being helped by their
    innovative, more holistic approach.
        If we are going to combat this problem, we can't
    concentrate on law enforcement alone. Florida should serve as
    an example to the rest of the country that only going after
    suppliers is insufficient. Let's be clear: the people who
    misuse opioids aren't the worst of the worst; they are our
    neighbors, our friends, parents, and children who are
    desperately in need of help. They often suffer in silence and
    isolation because of the stigma and shame surrounding drug
    abuse. Unfortunately, America learned this lesson the hard way
    treating the crack epidemic as simply a law enforcement
    exercise.
        We can't combat our opioid crisis without investing in new
    treatment options, long-term mental health and substance abuse
    recovery resources, and the men and women on the ground working
    in nonprofits and Government, collaborating with first
    responders and law enforcement, to help those in need in all of
    our communities. This includes funding for the Substance Abuse
    and Mental Health Service (SAMHSA) and the National Institutes
    of Health, which provides the research and innovative
    treatments not often permitted using traditional funding. This
    funding provides grants, including in Pinellas County, for
    innovative, local solutions for treating mental health and
    substance abuse disorders, like what's happening at ``Operation
    PAR'' and ``Bent Not Broken'' organization. This includes
    funding overdose reversal. We will lose this fight without
    naloxone. Americans will die unnecessarily. And because Florida
    did not expand Medicaid, funding for these organizations is
    even more vital, and something I hope your committee continues
    to prioritize in this ongoing battle.
        Thank you again for this opportunity to share how my home
    of Pinellas County is combating the opioid crisis. Thank you,
    Mr. Chairman and committee.

        Mr. Burgess. The gentleman yields back. The Chair thanks
    the gentleman.
        The Chair recognizes Mr. Faso for 3 minutes, please.

     STATEMENT OF HON. JOHN J. FASO, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF NEW YORK

        Mr. Faso. Thank you, Chairman Burgess, Ranking Member
    Green, and members of the committee for holding this important
    hearing and hosting all of us today.
        I appreciate and understand many of the testimonies we have
    heard from our colleagues. It is important to note that we
    represent districts that are often extremely different from
    each other--Democrat, Republican, rural, and urban. It is rare
    when an issue can unite not only a conference but an entire
    Congress.
        At the risk of speaking for my colleagues, I would like to
    express that we all stand together against the opioid epidemic.
    Now, in my district, in the 19th District in upstate New York,
    I can tell you a couple of stories.
        Greene County emergency responders recently reported to me
    they came upon a scene where they had two individuals who had
    overdosed. One individual required eight doses of Naloxone in
    order to be revived. Another required six.
        This is not an uncommon phenomena. County sheriffs had
    reported to me going back to the same household, the same
    apartments on the same evening to administer Narcan to revive
    people who have overdosed.
        Other county sheriffs have told me that every single drug
    dealer they arrest has public benefit and food stamp cards in
    their possession. It is ironic that we, the public, are often
    sustaining economically those that prey upon our citizens.
        In my district in the Board of Supervisors in Columbia
    County recently passed an opioid epidemic response plan. This
    plan is an enormous step forward to combatting the opioid
    crisis in our region.
        Ulster County has also substantially increased local
    funding to fight the crisis. Twin County Recovery Services in
    Columbia and Greene Counties is also serving those with
    addiction through clinical, residential, and educational
    programs.
        And I think the bottom line, Mr. Chairman, my colleagues,
    we have got to have educational programs that help us staunch
    the demand for these substances and not just try to staunch the
    supply.
        Congress must continue to help our local communities by
    ensuring they have the support and the 21st Century Cures and
    CARA, supporting SAMHSA legislation, and passing legislation
    such as the STOP Act to support our local law enforcement
    officers by making it more difficult for the U.S. Postal
    Service to ship fentanyl and carfentanyl through the mail.
        I recommend more research into how opioids affect the brain
    and learn more into how to defeat this chemical dependency.
        Our work is far from finished. We must stay engaged with
    each other, stay engaged with our communities and stay engaged
    with victims and families to truly effectuate and facilitate an
    authentic reversal of this dangerous and upward trend of opioid
    addiction in our communities.
        I thank the committee for their service and for allowing us
    to bring this testimony forth today.
        [The prepared statement of Mr. Faso follows:]

                    Prepared statement of Hon. John J. Faso

        Thank you, Chairman Burgess, Ranking Member Green, and
    members of the committee for holding this important hearing and
    hosting me today.
        I appreciate and understand many of the testimonies we have
    heard from our colleagues. It is important to note that we
    represent districts that are extremely different from each
    other; Democrat, Republican, rural, and urban. It is rare when
    an issue can unite not only a conference, but an entire
    Congress. At the risk of speaking for my colleagues, I would
    like to express that we stand together against the opioid
    epidemic.
        My particular district in upstate New York is fairly rural,
    Mr. Chairman.
        When we think of rural America, it evokes images of small
    towns, diners on the corners, two lane roads framed by family
    farms, and a community where neighbors look out for each other,
    and work hard for what they have.
        While all of these sentiments ring especially true in my
    district, so does the opioid crisis.
        Our local communities and counties across upstate are
    stepping up to the plate and finding ways to address this
    problem in a manner that meets their needs. With help from the
    State and Federal governments, our local governments and groups
    facilitate outreach programs, education programs, informational
    resources, trainings and working groups.
        In my district, the Board of Supervisors of Columbia County
    recently passed an Opioid Epidemic Response Plan. This plan is
    an enormous step forward in combating the opioid crisis in our
    region. Twin County Recovery Services is also another
    institution in my district serving those with addiction through
    clinical, residential, and educational programs. These
    initiatives enable local entities to most effectively help
    those with addiction, educate first responders, prevent future
    tragedies, and deploy Federal and State funding in our
    communities.
        I come before the committee today to implore my colleagues
    to work with me to empower local governments, that are closest
    to the crisis, to improve education and prevention programs and
    fight addiction on the front lines.
        Congress must continue to help our local communities by
    ensuring they have our support through means such as adequately
    implementing and funding CARA and 21st Century Cures,
    supporting SAMHSA (sam-sa) and passing legislation such as the
    STOP Act to support our local law enforcement officers by
    making it more difficult to ship fentanyl and carfentanil.
        I appreciate committee-led initiatives to work in a
    bipartisan-nature in passing ground-breaking addiction
    treatment legislation, holding numerous hearings to explore
    further Congressional action, and remaining open and inclusive
    during this process.
        Our work is far from finished. We must stay engaged with
    each other, stay engaged with our communities, and stay engaged
    with the victims to truly, and effectively facilitate an
    authentic reversal of this dangerous upward trend of opioid
    addiction.
        I stand ready to help the committee in this fight. Thank
    you.

        Mr. Burgess. Chair thanks the gentleman. The gentleman
    yields back.
        Chair recognizes Mr. Katko for 3 minutes, please.

    STATEMENT OF HON. JOHN KATKO, A REPRESENTATIVE IN CONGRESS FROM
                         THE STATE OF NEW YORK

        Mr. Katko. Thank you, Mr. Chairman and Ranking Member
    Green. I appreciate you giving me the opportunity to testify
    today about this most important topic and giving me the
    opportunity to not only discuss what has been being discussed
    but a possible partial solution to the problem from a law
    enforcement standpoint.
        And that is a bill that I introduced, H.R. 2851, the Stop
    the Importation Trafficking of Synthetic Analogs Act of 2017,
    which I will refer to as SITSA.
        I am driven in my testimony today and my support for this
    bill by two things. One is my 20 years as a Federal organized-
    crime prosecutor, prosecuting every manner of drug known to
    man, and knowing that, based on that experience, I have never
    seen anything that remotely resembles the tragic consequences
    of the current synthetic drug problem and the heroin issue in
    this country, and they are intertwined.
        And I can talk chapter and verse about what is going on in
    my community but I just want to introduce you to a few people
    that we have lost since I have been in Congress.
        John and Tina Socci lost their daughter, who was murdered
    in front of her 18-month-old child by her boyfriend, who was
    addicted to opioids. Two years later, still grieving the loss
    of their daughter, they lost their son to a heroin overdose.
    Their son was a drug counselor.
        Joe Campanella lost his son--I am sorry--Joe Campanella
    lost a son and his son was a drug counselor at the time, and
    John Socci and Tina Socci lost their son as well. Kevin Jones
    lost his stepdaughter.
        Theresa Wilson lost her son after he ingested synthetic
    marijuana that was purchased over the counter at a local head
    shop and he had convulsions and drowned.
        Deanna Axe--all these stories are tragic but this one is
    perhaps the worst--Deanna was a high school athlete, a great
    individual. She got involved with heroin after abusing opiates
    and she became pregnant. She went cold turkey and quit. She was
    five months pregnant and she had not had any relapses
    whatsoever.
        A drug dealer who I can only describe as one of the most
    reprehensible creatures on earth, cajoled her into trying one
    more time because a new mixture had come in. She tried it that
    one time and she died, and she lost her five-month-old child as
    well--unborn child.
        That is the face of this tragedy. That is the face of what
    is going on here and that is what I am trying to address with
    respect to the SITSA Act.
        Toxic synthetic drugs are designed to mimic street drugs
    like marijuana and what this drug is trying to do is recodify
    the problem. The problem I encountered when I was a prosecutor
    doing synthetic drugs prosecutions is that the statutes don't
    keep up.
        The drug that killed Theresa Wilson's son took 4 1A\1/2\
    years after they identified the chemical compound before it was
    listed in a drug analog statute.
        This bill that I have that has already passed the Judiciary
    and is simply waiting to get out of E and C before it can be
    voted on on the floor and I think will pass overwhelmingly
    turbo charges that process to reduce it to about 30 days, and
    it also, in a nutshell, will give individuals in Congress who
    may disagree with the classification of one of these drugs 180
    days after it is classified to have it removed through a
    congressional act.
        So I was going to talk much longer about it. I realize my
    time is up. But I can tell you from looking through the prism
    of a prosecutor there is three ways that you need to address
    this.
        Number one is law enforcement, number two is prevention,
    and number three is treatment. As my colleague, Mr. Faso,
    noted, we have done a lot with the CARA Act and other things to
    address prevention and treatment.
        This SITSA Act is something that law enforcement needs and,
    quite frankly, it is a game changer and I hope that E and C
    will consider it in a swift manner so it can get to floor for a
    vote and get into law and give another--put it in the arsenal
    for law enforcement to be able to attack this problem in a
    meaningful manner.
        And with that, I yield back, Mr. Chairman.
        [The prepared statement of Mr. Katko follows:]

                     Prepared statement of Hon. John Katko

        Thank you, Chairman Burgess, Ranking Member Green, and
    members of the Subcommittee on Health, for allowing me to speak
    today about the synthetic drug epidemic and my bill, H.R. 2851,
    the Stop the Importation and Trafficking of Synthetic Analogues
    (SITSA) Act of 2017.
        Synthetic drug abuse has crippled communities across this
    Nation, leading to countless tragedies in places like my
    district. This year, Syracuse area hospitals saw a record
    number of overdoses due to synthetic drug abuse. In May, over
    15 individuals had overdosed on synthetic drugs and were taken
    to the ER in the span of 24 hours. Unfortunately, stories like
    this have become the new normal. First responders and emergency
    room physicians across the Nation have seen incredible
    increases in calls due to synthetic overdoses, which is why
    they wholeheartedly support my legislation.
        Toxic, synthetic drugs are designed to mimic street drugs
    like marijuana, LSD, cocaine, ecstasy and other hard drugs.
    They can be more potent than the real thing and oftentimes are
    more deadly. Unfortunately, when law enforcement encounters and
    begins to combat a specific synthetic drug compound,
    manufacturers of these substances are able to slightly alter
    the chemical structure of the drug. This puts law enforcement
    at a serious disadvantage, leaving them constantly one step
    behind. As a former U.S. attorney, but more importantly, as a
    father, getting these drugs off the streets and out of the
    hands of our loved ones remains a top priority for me.
        Right before I introduced the bill, I met with a
    constituent in my district, Teresa Woolson, whose son was
    tragically killed by a synthetic drug identified as XLR-11.
    Unfortunately for Teresa, the drug that killed her son managed
    to remain legal and on the streets for 4 years after his death,
    until it was finally added to the controlled substances list.
    This is unacceptable and these families deserve to see justice.
        The potency and danger of synthetic drugs do not only
    threaten users, we are now seeing local law enforcement and
    first responders put in harm's way simply by coming in contact
    with these often lethal substances. Numerous cases across the
    country have resulted in emergency personnel becoming gravely
    ill and even dying while responding synthetic overdoses. The
    threats synthetic drugs pose to our communities and law
    enforcement must be stopped. H.R. 2851 takes a big step towards
    eradicating these harmful substances and protecting our
    communities.
        The SITSA Act will give local, State, and Federal law
    enforcement the necessary tools to target synthetic substances
    and the criminals who traffic them. Specifically, this
    legislation will create a new schedule to the Controlled
    Substances Act and establish a mechanism by which synthetic
    analogues can be temporarily or permanently added to that
    schedule in as little as 30 days after the chemical composition
    is determined by the Attorney General. The new schedule,
    Schedule A, will also add 13 synthetic fentanyls that have been
    identified by the DEA as an immediate threat to public health
    and safety. These synthetics have been confirmed as the cause
    of death in at least 162 cases in the United States. Finally,
    the bill maintains firm penalties for foreign manufacturing and
    importation and provides a multistep sentencing process which
    includes application of existing Federal guidelines. The goal
    of this legislation is to not only prevent drug abuse, but to
    facilitate proper research so that we may better understand
    these chemical compounds.
        The stories of synthetic drug abuse are in no way limited
    to my area of the country; this is a nationwide epidemic. I
    respectfully ask this subcommittee to consider the SITSA Act
    because every moment we fail to act; another person is effected
    by synthetic drugs.
        This summer, the Judiciary Committee unanimously passed
    this bipartisan legislation. We have worked with Members on
    both sides of the aisle as well as stakeholders across the law
    enforcement and health communities. I welcome your comments and
    amendments so that we can make this bill a powerful tool in
    eradicating these harmful substances.
        Again, I thank you for allowing me to testify this morning
    and urge this subcommittee to take action on H.R. 2851.

        Mr. Burgess. Gentleman yields back. Chair thanks the
    gentleman.
        The Chair recognizes the gentleman from Massachusetts, Mr.
    Keating, for 3 minutes, please.

       STATEMENT OF HON. WILLIAM R. KEATING, A REPRESENTATIVE IN
            CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS

        Mr. Keating. Thank you, Mr. Chairman.
        Let me just go off my notes and try and speak from the
    heart. Before I was a Member of Congress, I was a DA for 12
    years. Started a task force. Now, it's over a decade and a half
    on--at the time, heroin task force, but it was the result of my
    work as a DA.
        We would go to unattended deaths. We would find out that
    the person there had no criminal record. They started their
    addiction with prescription drugs, went to heroin--it was just
    cheaper, more available, believe it or not--and then they died.
        I consoled parents who lost the child. I worked with
    grandparents who were raising their children. In my own family,
    I lost a cousin to an overdose right after he was coming out of
    detox, the most dangerous time. On a brighter note, I have
    another family member a decade and a half in recovery.
        So I've seen this first hand. I've dealt with it in my
    district now. Since we are sharing that, one of my communities
    I share with Representative Kennedy.
        At Fall River, Mass., they are on pace for over a
    thousand--just this one city over a thousand overdoses this
    year and over a hundred deaths. It is the effect of fentanyl
    and carfentanyl in our area.
        In my district, I have four of the five leading counties in
    terms of opioid deaths.
        I want to thank this committee, though, for the work they
    have done with the CARA Act, with 21st Century Cures. You are
    working--I think that work is at risk if we backtrack on the
    availability of treatment through the ACA or another source
    because, as you know, 34 percent of the people before then did
    not have the guarantee of that treatment, which is important.
        Eighteen percent didn't have the coverage for mental health
    treatment that is necessary as well. In the Medicaid
    expansion--those States that did it--there is now 11 million
    low-income Americans covered by this.
        I also want to thank you on efforts that we've worked on a
    bipartisan basis. I worked on efforts with the STOP Act, which
    was part of this committee. I hope that it moves forward.
        Some of that is being done administratively where we look
    at making our drugs that are there tamper resistant--abuse
    resistant. Cosponsoring a Saves Act also, which allows a
    coprescription of Naloxone that is there--it solves the problem
    for the medical community and work with the veterans in terms
    of making sure they are educated.
        I just heard my colleague talk about the fact that we deal
    with this in three ways. The interdiction is limited. I just
    had a private meeting, since I am on Homeland Security, in my
    office with the leaders in terms of Customs and Border Patrol
    and what is going on.
        It is limited because so much of it's increased through the
    mail, through Fed Ex, through UPS. Very hard to deal with in
    that respect, although we should do what we can to do it.
        Prevention is important, obviously, in terms of medical-
    assisted treatment and dealing with the middle school
    population.
        Let me just conclude with this, because I was up last night
    thinking what I was going to say to you today. About 7 years
    ago when I got here, four Members of Congress, myself included,
    sat down with the FDA and people just to air out some real
    concerns. Only myself and Representative Hal Rogers are still
    here from that group.
        At the end of listening to us, all these experts came and
    they said, Congressman, you don't understand--you don't
    understand about medicine. You don't understand about medical
    treatment. We are there to deal with some pain and, you know,
    that is part of our reason.
        And I said--and I slammed the table and I said, you don't
    understand about pain--the pain of losing a son or a daughter,
    a grandchild. The pain of families--the pain of what it does to
    your income and work when this happens. That kind of pain
    doesn't go away.
        And we haven't progressed enough from that, frankly. It is
    great for this committee. It is great, I think, for myself to
    take whatever expert advice we can.
        But on this issue, people are depending on us. We've got to
    create the urgency and deal with it ourselves. We can't rely on
    other people to do it. In many cases, we are the court of last
    resort.
        We can do this. We can work together and we can make sure
    it can be done. But let's do it ourselves and let us take that
    leadership, and I want to thank you for the leadership you've
    shown in this, and I plan to work with you any way I can.
        Thank you.
        [The prepared statement of Mr. Keating follows:]

                 Prepared statement of Hon. William R. Keating

        Chairman Burgess, Ranking Member Green, and other
    distinguished members of the committee, thank you for the
    opportunity to testify about this critical issue.
        Dating back to my time as District Attorney, I have
    witnessed the devastation of the opioid crisis for nearly two
    decades. Countless families in my area have felt the effects,
    including my own. I have been called to sites of unattended
    deaths resulting from overdose. I have consoled parents who
    have lost a child to an overdose. I have worked with
    grandparents who are raising their grandchildren because of
    addiction. And all of this was before I got to Congress 7 years
    ago, when the number of opioid-related deaths was 45 percent
    lower than it is today. Today, we even have entire facilities
    dedicated to babies born addicted to opioids. As the members of
    this committee know, we cannot continue only to talk about this
    at arm's length. This goes beyond just numbers or statistics.
    People are feeling real pain. And we are losing an entire
    generation.
        The district I represent in Congress includes four of the
    top five counties in Massachusetts by opioid death rate.
    Further, Fall River, Massachusetts, a city I represent along
    with Congressman Kennedy, is projected to see at least 1,000
    opioid overdoses and over 100 deaths in 2017 alone. This is a
    horrible scourge for my constituents, and as evinced by the
    need for this hearing, a tragic epidemic nationwide.
        To begin, I thank this committee for their work guiding the
    House through enactment of two important laws, laws which laid
    meaningful groundwork for progress in battling the opioid
    crisis. The strategy outlined in the Comprehensive Addiction
    and Recovery Act (CARA) and the $1 billion in funding included
    in the 21st Century Cures Act have been significant steps in
    the right direction. More people have access to treatment, more
    health professionals understand early signs of addiction, and
    the number of opioid prescriptions has declined. However, some
    of the health legislation we have seen this year places this
    progress at risk.
        Prior to the Affordable Care Act (ACA), an estimated 34
    percent of insurance plans did not cover treatment for opioid
    use and other substance use disorders, and 18 percent did not
    provide coverage for any mental health conditions. The ACA
    required insurance policies to include this coverage.
    Similarly, the law's Medicaid expansion provided access to
    treatment for substance use disorders to 11 million low-income
    Americans. In fact, at an estimated $60 billion in coverage for
    behavioral health services each year, Medicaid is the largest
    source of funding for mental healthcare in the country--
    including services related to substance use disorders. Efforts
    to repeal the Affordable Care Act and cut funding for Medicaid
    place this coverage at grave risk. Accordingly, I am committed
    to defending the Affordable Care Act and preserving access to
    addiction treatment for all Americans.
        Aside from these concerns, I am encouraged that we do find
    consensus elsewhere. For example, we agree the solution to this
    crisis requires a multipronged approach. Last Congress, I
    introduced three bipartisan pieces of legislation aimed at
    combatting the opioid crisis from three different fronts. The
    first, the Stop Tampering of Prescription Pills Act, calls on
    the Food and Drug Administration to facilitate the creation of
    tamper-resistant formulations for commonly misused pain
    medication. The second, the Coprescribing Saves Lives Act,
    encourages physicians to coprescribe naloxone alongside opioid
    prescriptions and make naloxone more widely available in
    Federal health settings. The legislation also authorizes a
    grants program to funds State-level efforts to encourage the
    establishment of coprescribing guidelines, assist in the
    purchase of naloxone, fund training for health professionals
    and patients, and support patient copays. Last, the Safe
    Prescribing for Veterans Act outlines a common-sense plan to
    decrease opioid overuse among veterans by establishing a pain
    management continuing education requirement for opioid
    prescribers affiliated with the Department of Veterans Affairs.
    I look forward to working with my colleagues as I reintroduce
    these initiatives this Congress.
        We in this House are constantly learning about innovative
    approaches to pain management, improved methods of treating
    addiction, and novel ideas for opioid disorder prevention and
    education. There are even technologies that function as
    alternatives to pain medications, such as spinal cord
    stimulators implanted as long-term solutions to chronic pain. I
    appear before this committee ready to work on new approaches to
    caring for those who need help and ensuring our families, our
    neighbors, and all Americans have the resources they need as
    they seek a path down the road to recovery.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        The Chair recognizes the gentleman from Minnesota, Mr.
    Paulsen, for 3 minutes, please.

     STATEMENT OF HON. ERIK PAULSEN, A REPRESENTATIVE IN CONGRESS
                      FROM THE STATE OF MINNESOTA

        Mr. Paulsen. Thank you, Mr. Chairman, and also for this
    opportunity to speak about the opioid addiction in Minnesota.
        Minnesota is like the rest of the country. It is struggling
    with the crisis. It is tearing families apart through addiction
    and death and the numbers are only getting worse.
        Minnesota saw a 12 percent rise in opioid deaths from in
    2016 over 2015. The crisis affects Minnesotans of all
    backgrounds in rural communities, big cities, and in our
    suburbs.
        Just a year and a half ago in my hometown of Chanhassen, we
    saw the passing of music legend Prince due to an opioid
    overdose. In Minnesota, there are 50 opioid prescriptions
    written for every 100 patients that visit our doctors.
        Clearly, we need to change the culture and our delivery of
    care to stop the flow of opioids when there are proven
    alternative types of treatments that may not require those
    prescriptions.
        When someone requires surgery for back pain, they can
    choose between minimally invasive surgery or the standard
    surgery that requires a long post-surgery stay in the hospital
    and powerful painkillers.
        One way to reduce the dependency on opioids is to use
    procedures that are minimally invasive and do not require long
    hospital stays and opioids to dull the pain from other invasive
    procedures.
        An example is minimally invasive sacroiliac, or IS,
    infusion, which has been shown to reduce the need for dangerous
    pain killers.
        Unfortunately, some private insurers don't cover this
    procedure, forcing people to choose the standard surgery that
    requires addictive opioids for pain management.
        Instead of simply prescribing a drug for the pain,
    providers should also look to other therapies and insurers so
    they can proactively cover these therapies so that people are
    given more choices to manage their pain.
        We must hold providers and patients accountable and
    encourage insurers to cover more types of procedures. The
    opioid crisis also affects businesses including our local
    pharmacies.
        According to the DEA, in 2014 there were 16 armed robberies
    involving stolen opioids at Minnesota pharmacies. Last year,
    that number doubled. People get hurt and die during these
    crimes.
        Dangerous drugs are put on the street. Businesses have to
    close their doors because of safety concerns and communities
    lose vital resources and neighbors because of addiction and the
    crime that goes with it.
        Earlier this year, I spoke to a mom from Maple Grove,
    Minnesota, whose son bought carfentanyl online, consumed it,
    and died.
        We need to increase funding for safety resources, for
    addicts and trained law enforcement officers to spot and stop
    opioid-related crime.
        Our communities depend on access to health care and we need
    to do more to reduce the crime and death associated with opioid
    addiction if we are going to help get people--and get the care
    that they need.
        I want to thank you, Mr. Chairman. I look forward to
    working with you and the rest of the members on your committee
    for bipartisan solutions to the problems associated with opioid
    addiction.
        [The prepared statement of the Mr. Paulsen follows:]

                    Prepared statement of Hon. Erik Paulsen

        Thank you, Chairman Walden and Ranking Member Pallone, for
    this opportunity to speak about the opioid addiction crisis in
    Minnesota.
        Minnesota is like the rest of the United States in and
    unfortunately, it is suffering with addiction to and death from
    opioids.
        It's a crisis tearing families apart through addiction and
    death and the numbers are only getting worse. Minnesota saw a
    12 percent rise in 2016 over 2015-with 376 opioid related
    deaths. The crisis affects Minnesotans of all backgrounds in
    rural communities, big cities, and suburbs. In April 2016, in
    my hometown of Chanhassen, we saw the passing of music legend
    Prince due to an opioid overdose.
        In Minnesota, there are 50 opioid prescriptions written for
    every 100 patients that visit our doctors. Clearly we need to
    change the culture in our delivery of care to stop the flow of
    opioids when there are proven alternative types of treatments
    that may not require those prescriptions.
        When someone requires surgery for back pain, they can
    choose between minimally invasive surgery or the standard
    surgery that requires a long post-surgery stay in the hospital
    and powerful pain killers. One way to reduce the dependency on
    opioids is to use procedures that are minimally invasive and so
    do not require long hospital stays and opioids to dull the pain
    from other invasive procedures. An example is minimally
    invasive sak-roh-il-ee-ak joint, or SI fusion, which has been
    shown to reduce the need for dangerous pain killers.
        Unfortunately, some private insurers don't cover this
    procedure, forcing people to choose the standard surgery that
    requires addictive opioids for pain management. Instead of
    simply prescribing a drug for the pain, providers should look
    to other therapies and insurers should proactively cover those
    therapies so that people are given more choices to manage their
    pain. We must hold providers and patients accountable, and
    encourage insurers to cover more types of procedures.
        The opioid crisis also affects businesses, many times our
    local pharmacies. According to the DEA, in 2014 there were 16
    armed robberies involving stolen opioids at Minnesota
    pharmacies. Last year, that number doubled. People get hurt and
    die during these crimes, dangerous drugs are put on the street,
    businesses have to close their doors because of safety concerns
    and communities lose vital resources and neighbors because of
    addiction and the crime that goes with it.
        Earlier this year, I spoke to a mother Maple Grove, MN
    whose son bought carylfentanyl online, consumed it, and died.
    We must increase funding for safety resources for addicts and
    train law enforcement officers to spot, and stop opioid-related
    crime. Our communities depend on access to health care, but we
    must do something to reduce the crime and death associated with
    opioid addiction if we are going to help people get and keep
    the care they need.
        I thank you again, Mr. Chairman and Ranking Member Pallone,
    for allowing me this opportunity, and I look forward to working
    with to come up with more bipartisan solutions to the problems
    associated with opioid addiction.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        Chair recognizes the gentlelady from Delaware, Ms.
    Rochester, for 3 minutes, please.

      STATEMENT OF HON. LISA BLUNT ROCHESTER, A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF DELAWARE

        Ms. Blunt Rochester. Thank you, Mr. Chairman. Thank you,
    Mr. Chairman.
        I want to start off by saying as a former Deputy Secretary
    of Health and Social Services in Delaware, former Secretary of
    Labor, and community member and family member, substance abuse
    has touched my life and so many others, everything from our
    economy to our prison system to our families, from crack to
    heroin to all forms of opioids.
        And in many ways, Delaware reflects our Nation. Geography--
    we are urban and rural. We mirror the country in terms of
    demographics and, unfortunately, like the rest of the Nation we
    are facing a growing opiate crisis.
        Just yesterday, our death toll from this horrible disease
    rose to 171 Delawareans for the year. That might not seem like
    a lot to some, but to put that into perspective, that many
    deaths in a State the size of Delaware made us number 13 per
    capita in the country last year for opioid overdose deaths,
    according to the Kaiser Family Foundation.
        This public health crisis is prevalent in districts across
    the country, and Congress has the opportunity to impact it in a
    meaningful way and take action.
        This is why it's so important to tackle this issue on a
    bipartisan basis. The opioid addiction has taken a strong hold
    across the Nation and we must work together to combat the flow
    of drugs throughout our country.
        This is a problem for all States but particularly on the
    East Coast, where compact States means that none of us can act
    alone. Drug trafficking doesn't stop at Delaware's borders with
    Maryland or Pennsylvania or New Jersey, and neither does this
    public health crisis.
        Delaware and our neighbors have made great progress through
    collaborative programs like HIDTA and prescription drug
    monitoring programs. But that should just be the beginning. We
    aren't doing enough.
        But it is also important to remember that there are people
    in Delaware and in all of our communities making a difference.
    Every day on the ground for people, for families, and in
    neighbourhoods they are combatting this crisis on the ground.
        I want to thank all those people who are fighting, whether
    they are in public health, whether they are doctors, first
    responders, the faith community, community groups, families--
    all those who are doing their part to make sure that we tackle
    this issue.
        We in Congress need to join them. I hope that we in
    Congress will also continue to work together and address this
    epidemic by providing resources for prevention, support for
    recovery, and access to care.
        Thank you so much. I yield back my time.
        [The prepared statement of Ms. Blunt Rochester follows:]

                Prepared statement of Hon. Lisa Blunt Rochester

        In many ways, Delaware reflects our Nation. Geography--
    we're urban and rural, demographics, and unfortunately we are
    facing a growing opioid crisis.
        Just yesterday, Delaware's death toll from this horrible
    disease rose to 171 for the year. This public health crisis is
    prevalent in districts across the country and Congress has the
    opportunity to impact it in a meaningful way and take action.
    This is why it's so important to tackle this on a bipartisan
    basis.
        The opioid epidemic has taken a strong hold across the
    Nation, and we must work together to combat the flow of drugs
    throughout our country. This is a problem for all States, but
    particularly on the East Coast, where compact States mean that
    none of us can act alone. Drug trafficking doesn't stop at
    Delaware's borders with Maryland, or Pennsylvania, or New
    Jersey--and neither does this public health crisis. Delaware
    and our neighbors have made great progress through
    collaborative programs like HIDTA and prescription drug
    monitoring programs, but that should be just the beginning. We
    aren't doing enough.
        But there are people in Delaware, and in all of our
    communities, making a difference. Every day, on the ground, for
    people and families and neighborhoods they are combating this
    crisis on the ground. Thank you to the people who are
    fighting--the doctors, public safety officers, community
    groups, all of those doing what they can to help those around
    them. We need to join them.
        I hope that we, in Congress, will all continue to work
    together to address this epidemic by providing resources for
    prevention, support for recovery, and access to care.

        Mr. Burgess. Chair thanks the gentlelady. Gentlelady yields
    back.
        We are going to have a series of votes, and it is my hope
    that we will adjourn when votes occur. I am going to ask the
    Members who are here, and I appreciate you staying with us for
    so long.
        Let us continue to yield 3 minutes, but let's try to do it
    in 2 so everyone gets a chance to testify before the vote. So
    all the Members who remain, if you will join us at the table.
        And Ms. Chu, you are recognized for 3 minutes.

     STATEMENT OF HON. JUDY CHU, A REPRESENTATIVE IN CONGRESS FROM
                        THE STATE OF CALIFORNIA

        Ms. Chu. Mr. Chair, I want to start by thanking you for
    allowing Members to testify on this issue.
        Today, I would like to draw the subcommittee's attention to
    the significant needs of those who have sought help for
    addiction, completed treatment and are just beginning to live
    in recovery.
        These individuals often choose to live in sober living
    facilities after completing treatment in order to ease into the
    routines of daily life.
        However, there are far too many sober homes that are
    commonly unequipped to handle patients at risk of overdose or
    do not employ staff with specialty training for individuals in
    recovery.
        Worst of all, some of these facilities do not encourage
    recovery at all but exploit vulnerable people recently released
    from treatment in order to collect insurance payments.
        This could mean life or death for people like Tyler from my
    district of Pasadena, California, who died from an overdose
    after his sober home didn't recognize the symptoms of his
    overdose and didn't have Naloxone, the medication that can
    reverse an overdose. Tyler was only 23 years old.
        Unfortunately, this is not an isolated issue. I have heard
    from advocates in Arizona, Pennsylvania, Missouri, Ohio, and
    countless others who are concerned for their friends and
    neighbors living in unregulated sober living facilities.
        I would like to submit for the record a New York Times
    article from 2015 and a May 2017 report from the Department of
    Justice outlining abuse and fraud at sober homes in New York
    and Florida.
        Mr. Burgess. Without objection, so ordered.
        [The information appears at the conclusion of the hearing.]
        Ms. Chu. These reports describe sober living facilities
    that lacked access to Naloxone, ordered unnecessary tests on
    residents to exhaust their insurance benefits, and required
    residents to relapse and reenter treatment so resident
    directors could claim some of the Medicaid benefits.
        Licensing for recovery residences or sober living
    facilities vary substantially from State to State, and there
    are facilities in every State operating without licenses at
    all.
        Further, oversight of these facilities is minimal so
    patients and families with loved ones in recovery struggle to
    distinguish good actors from bad ones.
        For some individuals, they may not discover their facility
    is negligent until it is too late. That is why this week I plan
    to introduce the Ensuring Quality Sober Living Act. My
    legislation would require the Substance Abuse and Mental Health
    Services Administration to develop a set of best practices for
    residential recovery facilities so patients, families, and
    States can distinguish quality sober living facilities from
    sites that are fraudulent or unequipped to offer appropriate
    assistance.
        The bill would require SAMHSA to disseminate these best
    practices to each State and authorize the agency to provide
    technical assistance and support.
        My bill would require States to help SAMHSA set up criteria
    to distinguish quality sober living facilities. These best
    practices to allow the guidelines for common sense measures
    like requiring that all fees and charges be explained to
    residents before entering a binding agreement and that Naloxone
    is available and accessible and that staff and residents are
    trained to use it in emergencies.
        Thank you very much.
        [The prepared statement of Ms. Chu follows:]

                      Prepared statement of Hon. Judy Chu

        Chairman Burgess and Ranking Member Green, I want to start
    by thanking you for allowing Members to testify on this issue,
    which has impacted all of our districts.
        Today, I would like to draw the subcommittee's attention to
    the significant needs of those who have sought help for
    addiction, completed treatment, and are just beginning to live
    in recovery. These individuals often choose to live in sober
    living facilities after completing treatment in order to ease
    into the routines of daily life. However, ``sober homes'' are
    commonly unequipped to handle patients at risk of overdose, or
    do not employ staff with specialty training for individuals in
    recovery. Worst of all, some of these facilities do not
    encourage recovery at all, but exploit vulnerable recently
    released from treatment in order to collect insurance payments.
    This can mean life or death for people like Tyler, from my
    district of Pasadena, California, who died from an overdose
    after his sober home didn't recognize the symptoms of his
    overdose, or have Naloxone, the medication that can reverse an
    overdose, on hand. Tyler was only 23 years old.
        Unfortunately, this is not an isolated issue. I have heard
    from advocates in Arizona, Pennsylvania, Missouri, Ohio, and
    countless others who are concerned for their friends and
    neighbors living in unregulated sober living facilities. I
    would like to submit for the record a New York Times article
    from 2015 and a May 2017 report from the Department of Justice
    outlining abuse and fraud at sober homes in New York and
    Florida. These reports describe sober living facilities that
    lacked access to Naloxone, ordered unnecessary tests on
    residents to exhaust their insurance benefits, and required
    residents to relapse and re-enter treatment so resident
    directors could claim some of the Medicaid benefits.
        Licensing for recovery residences, or sober living
    facilities, varies substantially from State to State, and there
    are facilities in every State operating without licenses at
    all. Further, oversight of these facilities is minimal, so
    patients and families with loved ones in recovery struggle to
    distinguish good actors from bad ones. For some of these
    individuals, they may not discover that their facility is
    negligent until it is too late.
        That is why this week, I plan to introduce the Ensuring
    Quality Sober Living Act. My legislation would authorize the
    Substance Abuse and Mental Health Services Administration
    (SAMHSA) to develop a set of best practices for residential
    recovery facilities so patients, families, and States can
    distinguish quality sober living facilities from sites that are
    fraudulent or unequipped to offer appropriate assistance to
    their residents. The bill would require SAMHSA to disseminate
    these best practices to each State, and authorize the agency to
    provide technical assistance and support to States that wish to
    adopt or implement these best practices.
        My bill would allow States, who are struggling to address
    the opioid crisis, to work with SAMHSA to help set up criteria
    to designate quality sober living facilities. These best
    practices will follow the guidelines that have been published
    by the National Association of Recovery Residences, which
    provide benchmarks for various levels of quality facilities.
    These benchmarks include common-sense measures like requiring
    that all fees and charges be explained to residents before
    entering a binding agreement, that paid work performed at the
    facility be completely voluntary and not impede the recovery
    process, and that Naloxone is available and accessible, and
    that staff and residents are trained to use it in emergencies.
        Thank you again for taking the time to hear from your
    colleagues on ways to address this growing crisis. I ask that
    as you continue to consider legislation on the opioid epidemic,
    you include ways to address the needs of those newly in
    recovery.

        Mr. Burgess. Gentlelady's time has expired.
        The Chair recognizes the gentlelady from Indiana, Mrs.
    Walorski, for 3 minutes, please.

    STATEMENT OF HON. JACKIE WALORSKI, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF INDIANA

        Mrs. Walorski. Thank you, Mr. Chairman.
        Indiana is no different than any other State that we've
    heard from sitting here. Pain is the number-one reason why
    Americans seek health care, the number-one cause of disability
    that costs the U.S. economy more than $600 billion in direct
    health care costs and lost productivity.
        The veteran population is particularly impacted by the
    chronic pain crisis with more than 50 percent of the VA patient
    responding and reporting to chronic pain.
        We can reduce demand by more effectively treating chronic
    pain and providing better access to FDA-approved Nonopioid
    pharmaceuticals, advanced medical devices, and integrated
    alternative therapies.
        As we develop policy, we should, number one, recognize the
    importance of a multi disciplinary approach. Chronic pain is
    pervasive and is largely unaddressed by the public health care
    system.
        Promote--and number two, promote cutting-edge pain research
    to encourage effective opioid alternatives. High quality
    evidence is urgently needed to help clinicians and patients
    make informed decisions about how to manage chronic pain safely
    and understand the causes and mechanisms of chronic pain.
        Advanced best practices and pain management within
    Medicare. In 2016, one in three Medicare Part D beneficiaries
    received a prescription opioid. The GAO should conduct a study
    of the coverage options offered within Medicare for evidence-
    based pain management as an alternative to opioid
    prescriptions.
        Also, there should be a review of the graduate medical
    education programs' training and education of providers on pain
    management and opioid prescriptions.
        I hope these ideas will be helpful in future planning
    discussions to reduce the abuse of opioids in our communities.
        Thank you, Mr. Chairman. I yield back my time.
        [The prepared statement of Mrs. Walorski follows:]

                   Prepared statement of Hon. Jackie Walorski

        Thank you, Chairman Burgess and Ranking Member Green, for
    holding this hearing on the opioid crisis.
        America is facing two interrelated public health epidemics:
    chronic pain and opioid addiction, misuse, and abuse. A long-
    term solution to the opioid epidemic will not be achieved
    without addressing the challenge of appropriately treating
    chronic pain. According to the Institute of Medicine (IOM), 100
    million Americans suffer from chronic pain. Pain is the number
    one reason why Americans seek health care, the number one cause
    of disability, and costs the US economy more than $600 billion
    in direct healthcare costs and lost productivity. The veteran
    population is particularly impacted by the chronic pain crisis
    with more than 50 percent of VA patients reporting chronic
    pain.
        Thousands of lives are lost to both opioid-related overdose
    and chronic pain-related suicide. Reducing the supply of or
    access to opioids will not, by itself, solve this crisis.
    Currently, 80 percent of heroin users started with prescription
    opioids. We must reduce demand for them by more effectively
    treating chronic pain, and providing better access to FDA-
    approved nonopioid pharmaceuticals, advanced medical devices,
    and integrated alternative therapies.
        As we look to develop policy, we should:
        1. Recognize the importance of a multidisciplinary approach
    to pain management as a key component of overcoming the opioid
    crisis. Chronic pain is pervasive and largely unaddressed
    public health crisis. Solving it is a crucial part of solving
    the larger opioid epidemic.
        2. Promote cutting edge pain research to encourage
    effective opioid alternatives. High-quality evidence is
    urgently needed to help clinicians and patients make informed
    decisions about how to manage chronic pain safely and
    understand the causes and mechanisms of chronic pain.
        3. Advance best practices in pain management in Medicare.
    Currently 1 in 3 Medicare beneficiaries are prescribed an
    opioid. The GAO should conduct a study of the coverage options
    for evidence-based pain management. In addition, there should
    be a study conducted on the Graduate Medical Education program
    on the training and education that providers receive regarding
    pain management.
        I hope these ideas will be helpful in future policy
    discussions to reduce the abuse of opioids in our communities.
    Thank you for the time, and I yield back.

        Mr. Burgess. The Chair thanks the gentlelady.
        Mr. Donovan, you are recognized for 3 minutes.

     STATEMENT OF HON. DANIEL M. DONOVAN, JR., A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF NEW YORK

        Mr. Donovan. Thank you, Mr. Chairman.
        Chairman Burgess, Ranking Member Green, and members of the
    subcommittee, thank you for the opportunity to testify before
    you today to share my thoughts on the opioid crisis.
        This year alone, there have been more than 100 reported
    overdose deaths in my district. That number would be much
    higher if it weren't for the 574 Naloxone saves reported by our
    local hospitals and the New York City Police Department.
        Before I came to Congress, I served as district attorney of
    Richmond County, which comprises of Staten Island, New York.
    Based on that experience, my time in Congress, and input from
    local experts like the Staten Island Partnership for Community
    Wellness, I support a three-tiered approach for this problem
    that addresses education, treatment, and enforcement.
        Targeted education campaigns can teach the next generation
    of potential users about the dangers of substance abuse
    including particularly sinister compounds like fentanyl.
        Treatment is, of course, crucial. We have learned that
    recovery is a cycle and relapses will happen. Our policies
    should reflect that reality. Our society now understands that
    addiction is a medical illness and not a criminal act.
        Let us help the addicted, not punish them. To that end,
    consistently appropriating grants for local treatment programs
    is the most effective way to help end the cycle of addiction
    from the Federal level.
        Lastly, we cannot ignore the importance of enforcement,
    particularly against traffickers. My Comprehensive Fentanyl
    Control Act would ban pill presses that traffickers use to
    create their deadly fentanyl-laced cocktails. It would also
    update sentencing guidelines to reflect the fact that a few
    grains of--few grains of rice worth of fentanyl can kill an
    individual.
        I firmly believe that the experts on the ground are best
    equipped to tailor their approaches to meet their communities'
    needs. It is our job as legislators to provide them with the
    resources necessary to accomplish their mission.
        Legislation like the 21st Century Cures Act and the
    Comprehensive Addiction and Recovery Act, which I championed to
    constituents back in my district, are exactly the right
    approach.
        Thank you again for the opportunity to share my thoughts. I
    look forward to working with the subcommittee and to continuing
    to address this national crisis.
        Thank you, sir.
        [The prepared statement of Mr. Donovan follows:]

               Prepared statement of Hon. Daniel M. Donovan, Jr.

        Chairman Burgess, Ranking Member Green, and members of the
    subcommittee, thank you for the opportunity to testify before
    you today to share my thoughts on the opioid crisis.
        This year alone, there have been more than 100 reported
    overdose deaths in my district. That number would be much
    higher if it weren't for the 574 Naloxone saves reported by our
    local hospitals and the NYPD.
        Before I came to Congress, I served as District of Attorney
    of Richmond County, which comprises Staten Island, NY. Based on
    that experience, my time in Congress, and input from local
    experts like the Staten Island Partnership for Community
    Wellness, I support a three-tiered approach that addresses
    education, treatment, and enforcement.
        Targeted education campaigns can teach the next generation
    of potential users about the dangers of substance abuse,
    including particularly sinister compounds like fentanyl.
        Treatment is of course crucial. We've learned that recovery
    is a cycle and relapses will happen. Our policies should
    reflect that reality. Our society now understands that
    addiction is a medical illness and not a criminal act. Let's
    help the addicted, not punish them. To that end, consistently
    appropriating grants for local treatment programs is the most
    effective way to help end the cycle of addiction from the
    Federal level.
        Lastly, we can't ignore the importance of enforcement,
    particularly against traffickers. My Comprehensive Fentanyl
    Control Act would ban pill presses that traffickers use to
    create their deadly, fentanyl-laced cocktails. It would also
    update sentencing guidelines to reflect the fact that a few
    grains of rice worth of fentanyl can kill.
        I firmly believe that experts on the ground are best
    equipped to tailor their approaches to meet their community's
    needs. It's our job as legislators to provide them with the
    resources necessary to accomplish their mission. Legislation
    like the 21st Century Cures Act and the Comprehensive Addiction
    and Recovery Act--which I championed to constituents back in my
    district--are exactly the right approach.
        Thank you again for the opportunity to share my thoughts. I
    look forward to working with the subcommittee to continue
    addressing this national crisis.

        Mr. Burgess. Chair thanks the gentleman.
        Representative Hartzler, you are recognized for 3 minutes.

    STATEMENT OF HON. VICKY HARTZLER, A REPRESENTATIVE IN CONGRESS
                       FROM THE STATE OF MISSOURI

        Mrs. Hartzler. Thank you, Mr. Chairman.
        Mr. Burgess. But only use two.
        Mrs. Hartzler. And thank you for this opportunity.
        In Missouri, the scourge of drug abuse is a growing problem
    and it will take all of us to help solve it. I have heard of
    too many stories of families torn apart and livelihoods in
    tatters.
        To this end, I ask the committee to explore ways to make it
    easier for faith-based organizations to offer addiction
    treatment programs. I have seen firsthand the power of faith-
    based recovery programs in treating addiction.
        In my own district, I have visited multiple Christian
    organizations that have high rates of success in treating
    addiction.
        By centering on a community of faith, these organizations
    provide support structures that stay with recovering addicts
    their entire lives. In some cases, they also provide services
    that aren't available in other addiction recovery programs in
    the area.
        For instance, one religious organization in my district
    provides housing for both mothers and their children while the
    mothers seek treatment for their addiction. No doubt their
    recovery is greatly facilitated by the additional support of
    their children.
        I firmly believe faith-based recovery programs are part of
    a holistic approach to treat both the body and spirit. They
    provide emotional and spiritual support for individuals and
    their families during the darkest times and I ask the committee
    to seriously consider making available and expanding any and
    all funding opportunities to faith-based organizations
    providing addiction, treatment, and programs.
        In addition, on a second topic, the IMD exclusion caps the
    number of beds mental health facilities receiving Medicaid can
    have at 16. Multiple health care groups have come into my
    office saying this blocks critical access to treatment for
    people who need inpatient treatment for addiction including
    some of society's most vulnerable--veterans, pregnant addicted
    women, women with dependent children, and youth.
        I encourage the committee to explore ways to provide some
    relief to this outdated rule. Thank you very much. I yield
    back.
        [The prepared statement of Mrs. Hartzler follows:]

                   Prepared statement of Hon. Vicky Hartzler

        Chairman Burgess, Ranking Member Green, and members of the
    Subcommittee on Health, I thank you for the opportunity to talk
    today about the opioid crisis that's facing our Nation, and I
    appreciate the committee continuing to look for solutions to
    this ongoing epidemic.
        In Missouri, the scourge of drug abuse is a growing
    problem, and it will take all of us to help solve it. I have
    heard too many stories of families torn apart and livelihoods
    in tatters. Over one-twelfth of U.S. and Missouri adults report
    substance use disorders, and this rate is even higher among
    young adults. As we continue to address this problem, we must
    consider all avenues available. To that end, I ask the
    committee to explore ways to make it easier for faith-based
    organizations to offer addiction treatment programs.
        I have seen first-hand the power of faith based recovery
    programs in treating addiction. In my own district, I have
    visited multiple Christian organizations that have high rates
    of success in treating addiction. By centering on a community
    of faith, these organizations provide support structures that
    stay with recovering addicts their entire lives. In some cases,
    they also provide services that aren't available in other
    addiction recovery programs in the area. For instance, one
    religious organization in my district provides housing for both
    mothers and their children while the mothers seek treatment for
    their addiction. No doubt, their recovery is greatly
    facilitated by the additional support for their children.
        I firmly believe faith based recovery programs are part of
    a holistic approach that treat both the body and spirit. They
    provide emotional and spiritual support for individuals and
    their families during their darkest times. These religious
    organizations provide a foundation for recovery that medication
    assisted treatment alone cannot. It's the love and power of God
    and the life purpose He gives that ultimately provides a
    sustainable path to recovery for many individuals. I ask the
    committee to seriously consider making available and expanding
    any and all funding opportunities to faith based organizations
    providing addiction treatment programs.

                            Repeal the IMD Exclusion

        The IMD exclusion caps the number of beds mental health
    facilities receiving Medicaid can have at 16. Multiple health
    care groups have come into my office saying this blocks
    critical access to treatment for people who need inpatient
    treatment for addiction, including some of society's most
    vulnerable: veterans, pregnant addicted women, women with
    dependent children, and youths. I encourage the committee to
    explore ways to provide some relief to this outdated rule.

        Mr. Burgess. Chair thanks the gentlelady. Gentleman from
    Pennsylvania is recognized for 3 minutes, but only use 2,
    please.

      STATEMENT OF HON. BRIAN K. FITZPATRICK, A REPRESENTATIVE IN
             CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA

        Mr. Fitzpatrick. Thank you, Mr. Chairman.
        As this committee is aware, drug overdoses involving
    prescription opioids and heroin have nearly quadrupled since
    1999 and are now the leading cause of accidental death in this
    Nation.
        Substance abuses costs our country over $600 billion
    annually. In my home State of Pennsylvania, drug-related deaths
    and opioid addiction rates were amongst the highest in the
    Nation.
        Within one year, Pennsylvania's opioid-related deaths rose
    20 percent while my district's increased by 50 percent.
        Mr. Chairman, this epidemic is costing us both resources
    and precious lives, like my constituent, Carlos Castellanos.
    Carlos, in Falls Township, always loved sharing his talents and
    love of music by playing the guitar and drums at school for a
    local church group.
        However, like so many around the Nation, Carlos got
    involved with drugs during his time at school and even spent
    some time in jail. But with the strength and support of his
    family he began receiving treatment and his life improved. He
    helped others by volunteering at a recovery home and he brought
    people suffering in similar situations to treatment programs.
        Last December, Carlos walked his mother, Pamela, down the
    aisle for her wedding. He was getting ready to get back to
    school. He had a stead job and a girlfriend.
        It would seem that many of Carlos' battles with addiction
    were heading in the right direction, a needed point of hope in
    the war that has caused so much devastation.
        Then, Mr. Chairman, on December 23rd, just days before
    Christmas, two police detectives showed up at Pamela's door to
    tell her the devastating news that no mother can ever prepare
    for.
        Carlos overdosed on a drug laced with fentanyl and was
    unable to be saved.
        Mr. Chairman, Carlos' life and his death cast a bright
    light on the fact that addiction is nothing short of a chronic
    disease and I would also like to bring to this attention what
    my colleague did--the so-called Institute for Mental Disease,
    or IMD, exclusion is a longstanding policy that prohibits the
    Federal Medicaid matching funds to States for services rendered
    to Medicaid enrollees who suffer from substance use disorder
    for mental health treatment.
        Some States, like my State of Pennsylvania, have used the
    in lieu of services provision allowing for inpatient treatment
    but with limitations on population size, facility size and
    length of stay.
        These limitations disproportionately affect those using
    Medicaid, blocking access to treatment for people who need
    inpatient treatment for addiction including some of society's
    most vulnerable.
        I urge my colleagues to adopt the Road to Recovery Act, a
    bill I introduced which addresses real-world concerns expressed
    by local lawmakers, community leaders, and health care
    professionals.
        Mr. Chairman, I yield back.
        [The prepared statement of Mr. Fitzpatrick follows:]

                Prepared statement of Hon. Brian K. Fitzpatrick

        I would like to start off by thanking Chairman Burgess,
    Ranking Member Green, and members of the Subcommittee on Health
    for holding this hearing.
        Mr. Chairman, drug overdoses involving prescription opioids
    and heroin have nearly quadrupled since 1999 and are now the
    leading cause of accidental death. Substance abuse costs our
    country over $600 billion annually. In my home State of
    Pennsylvania, drug-related deaths and opioid addiction rates
    were among the highest in the country. Within 1 year,
    Pennsylvania's opioid-related deaths rose 20 percent while my
    district's increased by 50 percent.
        This epidemic is costing us both resources and precious
    lives.
        Carlos Castellanos of Falls Township, Bucks County always
    loved sharing his talents and love of music by playing the
    guitar and drums at school and for local church groups.
        However, like so many around the Nation, Carlos got
    involved with drugs during his time in school and even spent
    some time in jail. But, with the strength and support of his
    family, he began receiving treatment and his life improved. He
    helped others by volunteering at a recovery house and he
    brought people suffering in similar situations to treatment
    programs.
        In early December, Carlos walked his mother, Pamela, down
    the aisle for her wedding. He was getting ready to go back to
    school, he had a steady job, and a girlfriend. It would seem to
    many that Carlos' battle with addiction was heading in the
    right direction--a needed point of hope in a war that's caused
    so much devastation.
        Then, on December 23rd, just days before Christmas, two
    police detectives showed up at Pamela's door to tell her the
    devastating news that no mother can prepare for: Carlos had
    overdosed on a drug laced with fentanyl and was unable to be
    saved.
        Mr. Chairman, Carlos' life--and his death--cast a bright
    light on the fact that addiction is nothing short of a chronic
    disease.
        I share this story with Members of this chamber because we
    must realize that we have treat the whole person, not just the
    addiction. We must focus on the underlying issues driving
    people to seek opioids, while increasing the accessibility and
    affordability for prevention, education, treatment, and
    recovery of this disease. The so-called Institutions for Mental
    Diseases--or IMD--exclusion is a long-standing policy that
    prohibits the Federal Medicaid matching funds to States for
    services rendered to Medicaid enrollees who suffer from
    substance use disorder and mental health treatment.
        Some States--including my home State of Pennsylvania--have
    used an ``in lieu of services'' provision allowing for
    inpatient treatment, but with limitations on patient
    population, facility size, and length of stay. These
    limitations disproportionately affect those under Medicaid--
    blocking access to treatment for people who need inpatient
    treatment for addiction including some of society's most
    vulnerable.
        That is why I introduced bipartisan legislation that
    eliminates the IMD exclusion for substance use disorder and
    help States expand access to inpatient addiction services for
    Medicaid enrollees in a fiscally responsible manner while not
    intruding on their flexibility to implement care.
        The Road to Recovery Act addresses real-world concerns
    expressed by local lawmakers, community leaders and healthcare
    professionals in my district who endeavor to tackle this
    epidemic each day.
        I urge my colleagues to learn more about this issue and
    support this bipartisan bill, but also to recommit ourselves to
    addressing the addiction crisis and fighting for those who
    suffer.
        I yield back.

        Mr. Burgess. Chair thanks the gentleman.
        Chair recognizes the gentleman from Pennsylvania for 3
    minutes.

        STATEMENT OF HON. RYAN A. COSTELLO, A REPRESENTATIVE IN
             CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA

        Mr. Costello. Thank you, Mr. Chairman.
        In speaking with constituents about the opioid epidemic, I
    have learned firsthand the impact this epidemic is having on
    our communities in Pennsylvania. It is affecting families and
    individuals of all ages, races, and socioeconomic backgrounds.
        Throughout my congressional district and throughout this
    Nation there are parents, teachers, athletes, doctors,
    teenagers, and seniors struggling with addiction, a disease
    that has no boundaries when it comes to who it affects.
        These families and these individuals are why we must
    continue our work to pass legislation like the Comprehensive
    Addiction Recovery Act and the 21st Century Cures Act, two
    bills I supported that are both now law.
        These bipartisan bills are helping our communities through
    increasing access to treatment and expanding prevention,
    education, and intervention efforts.
        In the communities I represent, a recurring sentiment I
    have heard was, you would not believe how much treatment costs.
    The cost of treatment and recovery is, indeed, crippling for so
    many families, even for individuals who have insurance--$35,000
    for a 30-day at a treatment center, $10,000 for a 10-day detox,
    hundreds of dollars spent on flights to recovery programs
    across the country.
        Families are being forced to refinance their homes, parents
    are taking on second jobs, and retirees are reentering the
    workforce to help pay for treatment for a family member
    struggling with addiction.
        Those seeking help should not be faced with insurmountable
    costs. To help individuals provide assistance--financial
    assistance to family members struggling with addiction, I have
    added my name as a cosponsor to H.R. 1575, the Addiction
    Recovery through Family Health Accounts Act.
        Under current law, individuals can only use funds in their
    health savings account, flexible spending account, or health
    reimbursement arrangement to pay for addiction treatment for
    their spouse or dependents.
        This bill will give individuals the option to use funds
    from these accounts to help family members receiving drug
    treatment, be it a niece, grandfather, cousin, in-law, et
    cetera. This legislation is a step in the right direction in
    alleviating the financial burden of substance abuse treatment.
        I am proud of the work the committee has done to help those
    facing this epidemic and I am committed to continuing this
    work.
        I yield back. Thank you, Mr. Chairman.
        [The prepared statement of Mr. Costello follows:]

                  Prepared statement of Hon. Ryan A. Costello

        In speaking with constituents about the opioid epidemic, I
    have learned firsthand the impact this epidemic is having on
    our communities in Pennsylvania--it is affecting families and
    individuals of all ages, races, and socioeconomic backgrounds.
        Throughout my Congressional district and throughout this
    Nation, there are parents, teachers, athletes, doctors,
    teenagers, and seniors struggling with addition--a disease that
    truly knows no boundaries when it comes to who it affects.
        These families, these individuals are why we must continue
    our work to pass legislation like the Comprehensive Addiction
    and Recovery Act, and the 21st Century Cures Act--two pieces of
    legislation I supported that are both now law. These bipartisan
    bills are helping our communities through increasing access to
    treatment, and expanding prevention, education, and
    intervention efforts.
        In the communities I represent, a recurring sentiment I've
    heard was, ``you wouldn't believe how much money we've spent.''
        The cost of treatment and recovery is crippling, even for
    individuals who have insurance $35,000 for a 30-day stay at a
    treatment center. $10,000 for a 10-day detox. Hundreds of
    dollars spent on flights to recovery programs across the
    country.
        Families are being forced to refinance their homes, parents
    are taking on second jobs, and retirees are re-entering the
    workforce to help pay for treatment for a family member
    struggling with addiction.
        Those seeking help should not be faced with these
    insurmountable costs.
        To help individuals provide financial assistance to family
    members struggling with addiction, I have added my name as a
    cosponsor of H.R. 1575, the Addiction Recovery through Family
    Health Accounts Act.
        Under current law, individuals can only use funds in their
    Health Savings Account, Flexible Spending Account, or Health
    Reimbursement Arrangement to pay for addiction treatment for
    their spouse or dependents.
        This bill would give individuals the option to use funds
    from these accounts to help family members receive drug
    treatment--a niece, a grandfather, a cousin, a grandchild's
    spouse, in-laws, etc.
        This legislation is a step in the right direction in
    alleviating the financial burden of substance abuse treatment.
        I am proud of the work we have done in this committee to
    help those facing this epidemic, and I am committed to
    continuing this critical work.

        Mr. Burgess. Chair thanks the gentleman. Gentleman yields
    back.
        The Chair recognizes the final gentleman from Pennsylvania
    for 3 minutes, but only use 2.

        STATEMENT OF HON. KEITH J. ROTHFUS, A REPRESENTATIVE IN
             CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA

        Mr. Rothfus. Thank you, Mr. Chairman, for holding this
    important hearing today for Members across the country to come
    and testify about this epidemic.
        I think it is interesting that you have had three
    Pennsylvanians right in a row that represents the geography of
    Pennsylvania--eastern, middle, and western. Certain,
    communities in western Pennsylvania are among the hardest hit
    in our national opioid epidemic.
        There has been a staggering amount of overdose deaths
    specifically in my district. In 2016, Allegheny County had 648
    individuals lose their lives from heroin or opioid-related
    overdoses. Last year, that number was 4,342 in Pennsylvania
    alone.
        According to a recent article in the Pittsburgh Post
    Gazette in 2016, the number of overdose deaths in Pennsylvania
    was four times the number of deaths caused by car accidents.
        In other recent reports, three people in my district were
    revived by Narcan after each overdosed at a convenience store.
    Thankfully, the first responders were able to save their lives.
        While it is encouraging to see that both Congress and the
    administration have taken action to address this issue, we
    still have a long way to go. From my perspective, we should be
    taking a three-pronged approach to combatting the epidemic.
        We must implement measures to prevent addiction. We must
    treat addiction once it has taken hold over someone. Finally,
    we must vigorously enforce the laws on the books to stop drug
    traffickers from spreading their poison into our communities.
        To help combat this, I led an effort to include language in
    the landmark Comprehensive Opioid Reduction Act that will help
    ensure our veterans who are at significant risk to have access
    to the specialized program they need--program that they need to
    prevent or overcome opioid addiction. This is one positive step
    in the right direction.
        Another area where Congress should focus, one of which is
    of specific interest to me, is to increase and strengthen our
    partnership with Mexico, especially through the State
    Department's Merida Initiative.
        Our neighbor to the south has suffered a horrific level of
    murder at the hands of drug cartels. By increasing our
    cooperation with Mexico, we can help them defeat the cartels
    that caused so much pain both there and here in the U.S.
        Often overlooked is the fact that many of the narcotics
    that Mexican cartels traffic end up in the hands of Americans.
    Furthermore, increasing security at ports of entry through
    increased use of technology, cameras, and manpower is
    absolutely necessary to interdicting drugs.
        Pending legislation like Chairman McCaul's Border Security
    for America Act will do just that. Another bipartisan bill that
    I hope will end the crisis was introduced with Congress Collin
    Peterson, H.R. 3526. I look forward to that moving forward.
        Again, I sincerely thank you for the opportunity to testify
    before the committee this morning on an issue that greatly
    affects the constituents in my district.
        [The prepared statement of Mr. Rothfus follows:]

                  Prepared statement of Hon. Keith J. Rothfus

        Thank you Mr. Chairman for holding this important hearing
    today for members from across the country to testify about this
    epidemic.
        I think it is interesting that you've had three
    Pennsylvanians right in a row. It represent the geography of
    Pennsylvania; Eastern, Middle and Western.
        Certainly communities in Western Pennsylvania are among
    those hit hardest in the National opioid epidemic. There has
    been a staggering amount of overdose deaths, specifically in my
    district. In 2016, Allegheny County had 648 individuals lose
    their lives from heroin or opioid-related overdoses. Last year,
    that number was 4,342 in Pennsylvania alone.
        According to a recent article in the Pittsburgh Post-
    Gazette, in 2016, the number of overdose deaths in Pennsylvania
    was four-times the number of deaths caused by car accidents. In
    other recent reports, three people in my district were revived
    by Narcan after each overdosed at a convenience store.
    Thankfully, the first responders were able to save their lives.
        While it is encouraging to see that both Congress and the
    administration have taken action to address this issue, we
    still have a long way to go. From my perspective, we should
    take a three-prong approach to combating the epidemic.
        We must implement measures to prevent addiction. We must
    treat addiction once it has taken hold over someone. Finally,
    we must vigorously enforce the laws on the books to stop drug
    traffickers from spreading their poison into our communities.
        To help combat this, I led an effort to include language in
    the landmark Comprehensive Opioid Reduction Act that will help
    ensure our veterans, who are at significant risk, have access
    to the specialized programming they need to prevent or overcome
    opioid addiction. This is one positive step in the right
    direction.
        Another area where Congress should focus, one of which is
    of specific interest to me, is to increase and strengthen our
    partnership with Mexico, especially through the State
    Department's Merida Initiative. Our neighbor to the south has
    suffered a horrific level of murder at the hands of drug
    cartels. By increasing our cooperation with Mexico we can help
    them defeat the cartels that cause so much pain both there and
    here in the US. Often overlooked, is the fact that many of the
    narcotics that Mexican cartels traffic end up in the hands of
    Americans.
        Furthermore, increasing security at ports of entry through
    increased use of technology, cameras, and man-power is
    absolutely necessary to interdicting drugs. Pending
    legislation, like Chairman McCaul's Border Security for America
    Act, will do just that.
        Another bipartisan bill that I hope can help end the crisis
    is one that I introduced with Congressman Collin Peterson, H.R.
    3526 (the Border Protection Fund Act). I look forward to that
    moving forward.
        Again, I sincerely thank you for the opportunity to testify
    before the committee this morning on an issue that greatly
    affects my constituents and our country.

        Mr. Burgess. Chair thanks the gentleman. The gentleman
    yields back.
        All Members having had a chance to speak, with votes on the
    floor, the committee stands adjourned.
        [Whereupon, at 1:33 p.m., the subcommittee was adjourned.]
        [Material submitted for inclusion in the record follows:]

                    Prepared statement of Hon. Wm. Lacy Clay

        Good morning Mr. Chairman, Mr. Ranking Member, and
    honorable Members of this vital committee.
        I thank you for this special opportunity to come before
    you.
        I am here because, in 2016, 650 people in the St. Louis
    metropolitan area died from an opioid overdose.
        I am here because that number of needless, tragic deaths
    has quadrupled since 2007.
        I am here because the number of annual opioid overdose
    deaths in the community that I represent is now more than three
    times the number of homicides.
        I am here because this Congress must summon our national
    courage to finally confront the menace of opioid addiction and
    opioid overdoses as an urgent public health emergency.
        First, incarcerating people does very little to get at the
    underlying causes of this epidemic.
        We absolutely should not condone criminals who are peddling
    heroin, fentanyl, carfentanil and other deadly drug
    combinations.
        But just putting someone behind bars who has an addiction
    doesn't solve that person's problem. In fact, it is a huge
    waste of scarce taxpayer dollars that would be much better
    spent on treatment.
        Indeed, people who go to jail and are then released--if
    they are not given treatment--are at high risk of re-using and
    are also at a very high risk of a life-threatening overdose.
        I strongly believe in the value of life-saving and life-
    renewing services offered by community-based nonprofits that
    provide treatment for substance abuse disorders.
        We know that evidence-based treatment is effective and that
    when people are in treatment, they use drugs less and they
    overdose less.
        Treatment comes in many forms, but in the United States, we
    rely heavily on nonprofit community-based treatment providers
    as the safety net for treatment for low-income people and
    others who are disenfranchised, such as people who are
    homeless; many of whom are veterans.
        Many of these providers rely on the Substance Abuse
    Prevention and Treatment Block Grant to survive, and I would
    wholeheartedly urge that we continue to robustly fund this
    essential program.
        I do want to highlight the antiquated policy, over 50 years
    old, known as the Medicaid Institution of Mental Diseases
    Exclusion, better known as the IMD Exclusion, which bars
    Medicaid from paying for residential treatment at a facility of
    more than 16 beds.
        According to the New York Times in a July 10, 2014 article
    on the negative impact of the IMD Exclusion, in some States
    this policy means that 9 out of 10 treatment beds are in
    programs too large to receive Medicaid reimbursement.
        That is a huge barrier to recovery for our most needy, most
    vulnerable, poorest Americans--and it yields a two-tiered
    health care system, where only people on Medicaid lose access
    to a kind of treatment that may be clinically indicated and
    medically necessary.
        Fortunately, there is growing support for ending this
    outdated policy.
        For example, the National Governors Association has called
    for the elimination of the IMD Exclusion for SUD to help States
    expand access to addiction treatment.
        And in July 2017, the President's Commission on Combating
    Drug Addiction and the Opioid Crisis Interim Report recommended
    that all 50 States be granted waiver approvals to eliminate
    barriers resulting from the IMD exclusion.
        Perhaps most importantly in terms of legislative action,
    two key bills have been introduced in the 115th Congress that
    deserve your favorable consideration.
        One is H.R. 2938, sponsored by Rep. Brian Fitzpatrick of
    Pennsylvania, the Road to Recovery Act, which would eliminate
    the IMD Exclusion for community-based residential treatment.
        This is not a full repeal of the IMD Exclusion which also
    affects treatment for mental health, but rather is finely
    targeted to repeal the ban for the SUD treatment that is so
    sorely needed today amid the opioid epidemic.
        Another bill is H.R. 2687, the Medicaid CARE Act, sponsored
    by Congressman Bill Foster of Illinois, which would turn the
    current exclusion into a cap on Medicaid reimbursement, under
    which programs could be reimbursed for residential SUD
    treatment for up to 40 beds in a program for up to 60 days.
        These are just two ways that Congress can end one of the
    most formidable barriers to treatment, and immediately help
    increase capacity and beds in every State.
        Opioid addiction and the thousands of American lives it
    takes each year does not respect political parties, regional
    differences, racial or ethnic backgrounds or even age.it is an
    equal opportunity killer that we need to confront together as
    the People's House.
        Thank you for allowing me to share this time with you
    today, and I look forward to working closely with you in a
    bipartisan way to save our fellow Americans.

                    Prepared statement of Hon. Anna G. Eshoo

        Thank you, Chairman Burgess and Ranking Member Green, for
    holding this listening session and giving Members of the House
    the opportunity to speak about the tragic impacts of the opioid
    crisis in their districts. This crisis claims 142 lives each
    day and has killed more people than our deadliest wars. Over 2
    million people have a prescription opioid addiction, 591,000
    have a heroin addiction, and we've seen overdose deaths triple
    in the last 13 years. Opioid abuse touches every American and
    doesn't discriminate. It affects mothers, fathers, children and
    even newborn babies.
        I've heard from substance abuse treatment facilities in my
    congressional district and they report that the number of young
    people walking through their doors with addiction have
    strikingly increased in the past decade. This is a national
    crisis. These drugs are crippling a generation of America's
    youth.
        President Trump appropriately announced that he would
    declare it a national emergency in August, yet it has been 62
    days since he made that announcement and no emergency
    declaration has been filed.
        Instead, in the months since the President announced that
    he would declare the opioid crisis a national emergency, we've
    seen constant attacks on the very health care system that
    provides treatment and services to those suffering from opioid
    addiction. Medicaid and CHIP provide insurance coverage for 30
    percent of people suffering from opioid addiction. Medicaid has
    repeatedly been targeted by attempts to repeal the Affordable
    Care Act and now, through the Majority's tax reform plan. It's
    hypocritical to claim that you are committed to fighting this
    catastrophic crisis and then, at every turn, undermine the
    systems in place to treat and support those who struggle with
    addiction.
        Last Congress, we took important steps through the
    Comprehensive Addiction and Recovery Act and 21st Century Cures
    Act to address and treat opioid abuse, but both of these pieces
    of legislation must secure funding from Congress. We have to
    make good on the promises we made to those Americans who suffer
    from opioid addiction and fund the programs that they rely on
    to receive the treatment and support they need.
        Any future approach this committee or the administration
    takes must address the entire spectrum of addiction, from
    prevention, to crisis response, to treatment and recovery. A
    law and order approach that only punishes prescription drug
    abusers does a disservice to our country and impedes progress
    toward addressing this epidemic.

                  Prepared statement of Hon. Alcee L. Hastings

        Mr. Chairman, thank you for holding this important hearing
    about how the opioid epidemic is affecting communities
    nationwide. Today, I would specifically like to discuss the
    importance of repealing or reforming the Medicaid Institutions
    for Mental Diseases exclusion, which is a barrier to
    residential treatment for low-income people.
        Unfortunately, Mr. Chairman, one of my counties, Palm Beach
    County, Florida, saw nearly 600 fatal overdoses last year,
    mostly related to opioids. The number of fatal opioid overdoses
    has gone up 230 percent in the past 2 years, overwhelming
    police, firefighters, hospitals, and morgues. In fact, the
    Opioid crisis has been declared a public health emergency by
    Florida Governor Rick Scott.
        Recovering drug users are flocking to South Florida from
    everywhere--drawn by a world-renowned drug treatment industry.
    Some find good centers and a path to recovery. Others fall
    victim to corrupt operators and wind up homeless, without
    money, and in the most tragic cases, dead.
        Substance use disorder (SUD) plagues the United States both
    socially and economically. The cost of substance abuse and drug
    addiction to our health care system totals $705 billion
    annually, where the emotional costs of drug addiction, on
    family, friends and those battling addiction, cannot be
    calculated.
        An estimated 23.1 million Americans ages 12 or older needed
    treatment for substance abuse in 2012; however, only 2.5
    million of them actually received treatment. This shortfall is
    due primarily to the limited availability of substance use
    disorder services, particularly for those in need of
    residential care to address chronic addiction.
        Last year, I introduced a bill to amend title XIX of the
    Social Security Act and remove the exclusion of coverage for
    services in institutions of mental diseases (IMD) under
    Medicaid. My legislation is designed to enable more Americans
    who suffer from SUD to gain equal access to the treatment
    necessary for their long-term recovery.
        Under current law, Medicaid beneficiaries are barred access
    to community-based residential treatment for severe conditions
    due to the IMD exclusion that prohibits reimbursement care of
    patients at facilities with more than 16 beds. This nonsensical
    exclusion has effectively deterred facilities from serving
    those in dire need of care.
        Eliminating the IMD exclusion will allow those who suffer
    from severe substance use disorders to have equal access to
    treatment, to achieve stable, long-term recovery, and to become
    productive members of society. The IMD elimination will also
    reduce the health, public safety, and economic consequences
    associated with addiction.
        Addiction must be treated like any other chronic disease in
    this country, with a full continuum of treatment options based
    on the person's level of need. Current Medicaid policy hinders
    States' efforts to make this continuum available to Medicaid
    patients. My legislation would remove this Federal payment
    prohibition for behavioral health services provided in
    residential settings. Such a removal would improve access to
    substance use treatment services for millions of Americans
    across the country.
        The President's Commission on Combating Drug Addiction and
    the Opioid Crisis Interim Report recommended that all 50 States
    be granted waiver approvals to eliminate barriers resulting
    from the IMD exclusion. Providing health care services and
    treatment resources to those who suffer from substance abuse is
    critical. In the face of this opioid epidemic, our Nation
    cannot afford to continue to bear the unintended constraints of
    50-year-old provision under Medicaid, which severely impedes
    availability and access to treatment.
        Once again, Mr. Chairman, I want to thank you for holding
    this critically important hearing today, and greatly appreciate
    the opportunity to testify for your subcommittee.

                   Prepared statement of Hon. David P. Joyce

        I would like to thank Chairman Burgess, Ranking Member
    Green, and the other Members of the Energy and Commerce
    Subcommittee on Health for holding this important and timely
    hearing. As an Ohio Member of Congress, and a former prosecutor
    of 25 years, I have seen firsthand the devastation caused by
    this epidemic.
        This is why I introduced my legislation, the Stem the Tide
    of Overdose Prevalence from Opiate Drugs Act of 2017, or the
    STOP OD Act. I went straight to the source to craft this bill,
    gathering input from the healthcare experts that are treating
    overdose patients on a daily basis. Cleveland Clinic,
    MetroHealth, and University Hospitals were instrumental in the
    drafting of the STOP OD Act, and endorsed it in its final form.
    The bill also has the support of the Fraternal Order of Police
    (FOP), Community Anti-Drug Coalitions of America (CADCA), and
    the Association of the United States Navy (AUSN). We wanted to
    know what our local communities needed, so we took their
    invaluable feedback, developed a bill that would provide
    resources where necessary, and then identified a savings
    measure to pay for those resources.
        As a Congress, we have made progress in this arena, but
    there is more work to be done. As an original cosponsor of my
    colleague's Comprehensive Addiction and Recovery Act of 2015, I
    was proud when that piece of critical legislation passed both
    Chambers and was signed into law. My legislation is intended to
    be complementary to that effort. Although CARA roll-out is
    still a work in progress, more and more victims are overdosing
    every day, and our communities in Ohio are still communicating
    the need for more resources. The longer we wait to provide
    these resources, the harder this epidemic will be to address in
    the future. This is a downhill snowball and we need more
    firepower.
        First and foremost, the STOP OD Act would make available
    grants for not more than $150 million annually for 2 years to
    provide access to life-saving Naloxone, training in the
    administration of the drug, and for coroners and medical
    examiners to test for fentanyl so we can get a better idea of
    just how deep this problem runs. Further, the bill would attach
    a fee of $80 to drug-related offenses to ensure criminals that
    are enabling the supply and demand of the drug trade pay into
    mitigating the consequences of their actions. The fee goes
    toward paying for the grant programs under this bill, and after
    2 years toward paying down the Federal debt.
        The STOP OD Act also makes available grants for not more
    than $75 million annually for 2 years to expand educational
    efforts to prevent opiate abuse, promote treatment and
    recovery, and promote the understanding that addiction is a
    chronic disease. The educational grants, coupled with the
    Naloxone grants, total $450 million. That's the maximum grant
    allocation. In addition to the fee for drug offenses, this bill
    contains a pay-for to completely cover the maximum grant
    allocation. I worked with GAO to identify savings of at least
    $500 million by extending the current data center consolidation
    initiative. That effort is set to sunset in 2018, but the STOP
    OD Act would authorize the extension of that program for 2 more
    years, and would put those savings toward these grants, which
    will save lives and prevent further addiction. This bill works
    on the front end and the back end to address this crisis.
    Naloxone can resuscitate a victim of overdose. Meanwhile, we
    can utilize the other grant pool to educate our communities
    about the dangers of these drugs. We need a multifaceted
    approach to tackling this problem. This legislation is an
    important step toward our shared goal: ending the opiate drug
    overdose epidemic that is ravaging our great Nation. Moreover,
    I want to note that, as of this week, my legislation has a
    total of 46 bipartisan cosponsors, exactly evenly split between
    Republicans and Democrats, and spanning 20 States. It's clear
    that no matter which side of the aisle you are on, your
    community has probably been affected by this epidemic, and you
    want to take even more action to address it. That's what I am
    seeing when talking to my colleagues, and the bottom line here
    is: this bill will do some good.
        Thank you again for holding this hearing, and for inviting
    members outside the committee to weigh in and contribute our
    legislative proposals for your deliberation moving forward. I
    am happy to answer any questions regarding my legislation. I
    appreciate your time and consideration.

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                  Prepared statement of Hon. Stephen F. Lynch

        Good morning. Chairman Burgess, Ranking Member Green, and
    members of the Energy and Commerce Subcommittee on Health,
    thank you for the opportunity to submit my testimony for the
    record, and thank you for holding this important hearing.
        Mr. Chairman, my State of Massachusetts was hit early on
    and has suffered greatly from this crisis. In the late 1990's,
    South Boston saw a disturbing uptick in the number of teen
    deaths, many of which were related to Oxycontin and heroin
    abuse. At the time, I worked to help establish the Cushing
    House Recovery Home for Adolescents, a drug and alcohol
    rehabilitation clinic in South Boston for teenagers. This
    initiative was just one of the many that the Commonwealth, at
    the State and local levels, has undertaken as part of a
    multifaceted approach to tackling this problem. Other
    initiatives include instituting a Prescription Monitoring
    Program, making addiction treatment facilities and services
    more accessible, increasing awareness of the scope of the
    epidemic, working with doctors to reduce the length of time
    that they prescribe opioids, and supporting innovative
    intervention efforts to reduce the rate of overdose deaths.
        Recent State statistics are showing that we are making an
    impact, but that we cannot afford to pull back on these
    efforts. In 2016, 2,107 citizens of Massachusetts died from an
    overdose. That level was an increase of 17 percent compared to
    2015, which saw an increase of 31 percent, and 2014 in which
    the death toll rose by 40 percent. We cannot be satisfied with
    only slowing down the rates of death: we must instead double
    down on the effective and proven initiatives that are saving
    lives.
        This brings me to the concerns I have that the Majority is
    pushing legislation that will undercut the efforts being
    undertaken both in my State and across the country. Recent
    bills to repeal the Affordable Care Act have included
    provisions that undermine Medicaid, which, according to the
    Kaiser Family Foundation, covers 3 in 10 nonelderly adults with
    opioid addiction. In addition, these bills would have allowed
    States to opt out of covering addiction treatment and the
    mental health services that are necessary to ensure that
    recovery is sustainable. Legislative actions such as these will
    only worsen the crisis and threaten the still-fragile progress
    that has been made so far. Separately, I am also concerned by
    the recent omnibus spending package that included a cut of $306
    million to the Substance Abuse and Mental Health Services
    Agency (SAMHSA). These cuts in funding and in coverage will
    only worsen the epidemic.
        Mr. Chairman, our country lost nearly 60,000 of our fellow
    Americans to the opioid epidemic last year. We must ensure that
    we are doing everything in our power to provide those families
    and individuals who are battling addiction with the support and
    help they need to overcome this destructive disease. In
    particular, we must ensure that the programs and initiatives
    that can help them will be funded and available.
        Thank you very much for the opportunity to testify.

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                  Prepared statement of Hon. Richard M. Nolan

        Chairs Walden and Burgess and Ranking Members Pallone and
    Green,
        Thank you for inviting me to submit testimony for today's
    House Energy and Commerce Subcommittee on Health's Member Day.
        Make no mistake about it--the abuse of opioids and other
    prescription drugs has become an epidemic and a crisis of major
    proportion in this country.
        According to the latest figures from the Department of
    Health and Human Services, 33,000 people die every year from
    overdoses.
        And 12.5 million people misuse and abuse opioids and
    prescription drugs every year.
        The fact is--in just a very few generations, we've
    increased the life expectancy in this country from less than 50
    years to nearly 80. And the Centers for Disease Control
    recently concluded that our life expectancy would be even
    higher but for this epidemic of prescription drug misuse.
        With all that in mind--there is probably no more innovative
    or successful intervention program in the country than the
    community-based model being undertaken in Minnesota by CHI-St.
    Gabriel's & Morrison County Prescription Drug Abuse Project.
        Their model--which at my invitation has been presented to
    Congressional staff twice now--has produced tremendous results
    by bringing together doctors, nurses, pharmacists, social
    workers, law enforcement, home health and skilled nursing
    professionals and educators in the communitywide effort you
    will hear about today.
        The results speak for themselves.
        In the community of Little Falls, the four participating
    pharmacies have experienced a 23 percent decrease in controlled
    substance prescriptions.
        324 patients have tapered off controlled substances
    entirely, primarily through the use of suboxone.
        And what that means is--370,000 fewer controlled substances
    have entered the community since the program began. At about $7
    per dose, that's a savings of about $2.6 million every year for
    patients in Morrison County.
        And what's more, in the first 8 months of the program
    alone, pain went from the number one reason people were being
    admitted to the Emergency Room--to not even in the top 20.
        The fact is, doctors are not only managing pain better, but
    they are doing it with many new and effective options that
    don't include long term use of narcotics.
        This program has become a model for our entire Nation, and
    I wanted to share it with the committee today for their
    awareness and examination.
        In closing, thank you for convening this hearing today--and
    helping us all move forward to put an end to this crisis that
    is affecting so many lives and families and communities.

                    Prepared statement of Hon. Niki Tsongas

        Mr. Chairman, Ranking Member, and members of the House
    Committee on Energy and Commerce Subcommittee on Health, thank
    you for the opportunity to submit testimony today on the opioid
    epidemic, a health crisis indiscriminately affecting
    communities across this country.
        In my home State of Massachusetts, there were an estimated
    2,107 opioid-related deaths in 2016, an increase of over two-
    hundred percent in the last 10 years. To put that increase in
    perspective on a national level, according to news reports, in
    2016, more Americans died of drug overdoses than have ever died
    from car crashes, gun violence, or HIV/AIDS during any single
    year.
        Thanks to the work of this committee, Congress has taken
    several steps to begin to address this crisis, but the stunning
    rise in opioid misuse, addiction and deaths calls on us to do
    more.
        When people become addicted to painkillers, and then lose
    access to their prescription drug, many turn to illegally
    obtaining cheaper, more potent opioids such as heroin and
    synthetic drugs.
        According to the most recent data from the Centers for
    Disease Control and Prevention, across the United States, over
    21,000 overdose deaths were caused by synthetic opioids between
    February 2016 and February 2017, twice as many as the previous
    12-month period. One of the leading contributors to this number
    is fentanyl, a deadly synthetic opioid that can be up to 50
    times stronger than heroin and 100 times more powerful than
    morphine. Fentanyl has become the leading cause of overdose
    deaths nationwide, surpassing heroin in the summer of 2016.
        Although pharmaceutical fentanyl can be misused, most
    fentanyl deaths are linked to illicitly manufactured fentanyl
    and illicit versions of chemically similar compounds known as
    fentanyl analogs.
        In Massachusetts, the proportion of overdose deaths
    attributed to fentanyl is rising at a meteoric rate. At its
    lowest, in the third quarter of 2014, fentanyl was present in
    18 percent of opioid-related deaths in Massachusetts. However,
    in 2016, fentanyl was present in a staggering 69 percent of the
    State's opioid-related deaths, resulting in 1,400 fentanyl-
    related deaths in the Commonwealth.
        The primary sources of fentanyl are outside the United
    States, principally Mexico and China. The drug is smuggled
    across the U.S. border or delivered through the mail or private
    carriers. Fentanyl can also be ordered online. And because of
    its extreme potency, fentanyl typically comes in small amounts,
    making it more difficult for authorities to detect.
        That is why earlier this year I introduced bipartisan
    legislation with Congressman Brian Fitzpatrick (R-PA) to
    provide Customs and Border Protection (CBP) with the latest in
    chemical screening devices and scientific support to detect and
    intercept fentanyl and other synthetic opioids.
        Not only would these devices allow law enforcement to
    detect and confiscate fentanyl before it enters the United
    States, but it would also protect law enforcement officers on
    the front lines from exposure to the deadly narcotic, which is
    so powerful that coming into contact with just a few grains can
    be fatal.
        The House Committee on Homeland Security recently passed
    our bill, the International Narcotics Trafficking Emergency
    Response by Detecting Incoming Contraband with Technology, or
    INTERDICT, Act by voice vote and we are now urging House
    leadership to bring it to the floor.
        The INTERDICT Act would be an important step towards
    stemming the rapid influx of illicit synthetic opioids,
    including fentanyl. However, to most effectively have an impact
    on this heart-wrenching epidemic, we must establish a
    comprehensive, fully funded plan at the local, State, and
    Federal level. Congress must continue to demonstrate its
    commitment to ending this epidemic by supporting the programs,
    agencies, organizations and individuals on the front lines.
        We cannot afford to let our friends, family members and
    neighbors suffer under the burden and stigma of addiction and
    mental illness--especially given the scope and magnitude of the
    issue nationwide. My colleagues from all parts of the country,
    both Democrats and Republicans, have heard similar stories from
    their districts and we owe it to our communities to do all we
    can to head off this national epidemic.

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