[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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