[House Hearing, 115 Congress] [From the U.S. Government Publishing Office] OFFICE OF NATIONAL DRUG CONTROL POLICY: REAUTHORIZATION IN THE 115TH CONGRESS ======================================================================= HEARING BEFORE THE COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM HOUSE OF REPRESENTATIVES ONE HUNDRED FIFTEENTH CONGRESS FIRST SESSION __________ JULY 26, 2017 __________ Serial No. 115-35 __________ Printed for the use of the Committee on Oversight and Government Reform [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Available via the World Wide Web: http://www.fdsys.gov http://oversight.house.gov ______ U.S. GOVERNMENT PUBLISHING OFFICE 27-603 PDF WASHINGTON : 2018 ----------------------------------------------------------------------- For sale by the Superintendent of Documents, U.S. Government Publishing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC 20402-0001 Committee on Oversight and Government Reform Trey Gowdy, South Carolina, Chairman John J. Duncan, Jr., Tennessee Elijah E. Cummings, Maryland, Darrell E. Issa, California Ranking Minority Member Jim Jordan, Ohio Carolyn B. Maloney, New York Mark Sanford, South Carolina Eleanor Holmes Norton, District of Justin Amash, Michigan Columbia Paul A. Gosar, Arizona Wm. Lacy Clay, Missouri Scott DesJarlais, Tennessee Stephen F. Lynch, Massachusetts Blake Farenthold, Texas Jim Cooper, Tennessee Virginia Foxx, North Carolina Gerald E. Connolly, Virginia Thomas Massie, Kentucky Robin L. Kelly, Illinois Mark Meadows, North Carolina Brenda L. Lawrence, Michigan Ron DeSantis, Florida Bonnie Watson Coleman, New Jersey Dennis A. Ross, Florida Stacey E. Plaskett, Virgin Islands Mark Walker, North Carolina Val Butler Demings, Florida Rod Blum, Iowa Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia Jamie Raskin, Maryland Steve Russell, Oklahoma Peter Welch, Vermont Glenn Grothman, Wisconsin Matt Cartwright, Pennsylvania Will Hurd, Texas Mark DeSaulnier, California Gary J. Palmer, Alabama Jimmy Gomez,California James Comer, Kentucky Paul Mitchell, Michigan Greg Gianforte, Montana Sheria Clarke, Staff Director William McKenna General Counsel Mary Doocy, Counsel Sarah Vance, Professional Staff Member Sharon Casey, Deputy Chief Clerk David Rapallo, Minority Staff Director C O N T E N T S ---------- Page Hearing held on July 26, 2017.................................... 1 WITNESSES Mr. Richard Baum, Acting Director, Office of National Drug Control Policy Oral Statement............................................... 5 Written Statement............................................ 8 Ms. Diana Maurer, Director of Justice and Law Enforcement Issues, U.S. Government Accountability Office Oral Statement............................................... 27 Written Statement............................................ 29 Keith Humphreys, Ph.D., Professor of Psychiatry and Behavioral Sciences, Stanford University Oral Statement............................................... 46 Written Statement............................................ 48 Mr. Don Flattery, Addiction Policy Advocate and Impacted Parent Oral Statement............................................... 51 Written Statement............................................ 54 APPENDIX Letter of May 16, 2017, to the Office of Management and Budget, submitted by Ms. Norton........................................ 82 OFFICE OF NATIONAL DRUG CONTROL POLICY: REAUTHORIZATION IN THE 115TH CONGRESS ---------- Wednesday, July 26, 2017 House of Representatives, Committee on Oversight and Government Reform, Washington, D.C. The committee met, pursuant to call, at 10:41 a.m., in Room 1100, Longworth House Office Building, Hon. Trey Gowdy [chairman of the committee] presiding. Present: Representatives Gowdy, Jordan, DesJarlais, Massie, Meadows, Ross, Walker, Blum, Hice, Russell, Grothman, Comer, Gianforte, Norton, Clay, Lynch, Connolly, Watson Coleman, Plaskett, Demings, Krishnamoorthi, Welch, and DeSaulnier. Chairman Gowdy. The Committee on Oversight and Government Reform will come to order. Without objection, the chair is authorized to declare a recess at any time. Before Mr. Connolly and I give our opening statements, I do want to thank everyone, our guests, our panelists, those in the audience, the members and staff, and everyone, for how accommodating you were this morning. We had an unforeseen contingency that arose in our normal hearing room. So thank you for being so understanding. Over the past 2 decades, illicit drug use has emerged as a public health and safety crisis, with overdoses becoming the leading cause of injury or death in the United States. Opioids, specifically heroin and prescription pain relievers, are the cause of most overdose deaths in the United States, with the death rate more than doubling since the year 2000. In South Carolina, which is where I'm from, at least 95 people died from heroin in 2015, which is almost twice as many as the previous year. And more than 560 died from the abuse of prescription opioids over the same period of time. The epidemic is growing and lives are at stake, literally. It is imperative our Nation maintain a strong coordinated effort across the Federal Government to combat drug abuse from design, manufacturing, distribution, prescription, and consumption. In 1988, Congress established the Office of National Drug Control Policy as part of the Anti-Drug Abuse Act to coordinate drug programs across the Federal Government, advise the administration on national and international drug control policies, and create and oversee the National Drug Control Budget. ONDCP is uniquely equipped to address what role the Federal Government can play in determining what kinds of clinical, social, welfare, and economic programs could impact and reverse drug abuse problems in our country. ONDCP was last authorized in 2006. The authorization lapsed in 2010, but the office has continued to receive appropriations each year. In December 2015, this committee held a hearing to discuss various proposals for reauthorization. We heard from the then director who testified combatting the abuse of prescription drugs was a top priority for the agency. However, since then, ONDCP has failed to produce a formal National Drug Control Strategy and a National Drug Control Budget, which is supposed to be released no later than February 1 each year. In the meantime, deaths due to opioid overdoses have only increased in the U.S. in 2016. No office is perfect. God knows Congress certainly is not, but it is our responsibility, nonetheless, to see that deadlines are met, particularly statutory deadlines, resources are well spent, and the leadership that can be provided nationally is being provided. There is a prevention aspect, a treatment aspect, an education aspect, an enforcement aspect, a punishment aspect, and an oversight aspect, the Federal Government has long occupied a space as it relates to both the illicit use of legal drugs and the use of illegal drugs. Today, we will have an opportunity to consider options for reauthorizing ONDCP and learn about how this agency can work for the goal of reducing and ultimately eliminating our Nation's opioid crisis. We will also examine how ONDCP can help mitigate the significant harm communities across America have felt as a result of our Nation's opioid crisis. There are many areas worthy of exploration today, and we thank all of our witnesses for appearing before the committee. We look forward to your testimony as we consider next steps for reauthorization. And with that, I would recognize my friend from Virginia. Mr. Connolly. I thank the chair, and I want to thank him personally for having this hearing. I also want to thank him personally for his absolute willingness to accommodate our witnesses and to hear the case for why we felt, especially Mr. Flattery being added, really would add a dimension of a personal story that Mr. Flattery has courageously been willing to share. And I just thank my friend from South Carolina. And this is an area where we can find common ground, where bipartisan cooperation must occur, and I know the chairman is committed to doing it, as am I. We're in the midst of a national public health emergency. The opioid epidemic has taken thousands, tens of thousands of lives across America, and unfortunately, shows no signs of ending. Every day, every day, 91 Americans die from an opioid overdose. This epidemic doesn't care where you live or what political party you belong to. The crisis has touched every corner of our Nation. Where I come from, Northern Virginia, is no exception. Fairfax County, which I chaired for 5 years, reported more than 100 drug-related deaths last year. Prince William County, the other county I represent, reported 52. These are astronomical numbers by our normal standards. Today, we have on our panel Don Flattery, a father from Fairfax County, and his wife has joined him here today too. His son, their son, Kevin, tragically lost his life to opioid overdose 2 years ago--3 years ago. Kevin was a graduate of the University of Virginia. He aspired to a career in film making, but he became addicted to OxyContin because of a medical prescription and a particular medical condition, and he died at the age of 26. Mr. Flattery has been an outspoken advocate for the need to address this crisis, and we all welcome his testimony here today. Every day, people across the country die from drug addiction. Families are torn apart. Americans are suffering. The crisis cannot wait. As Members of Congress, we've got to do everything we can to assist and ameliorate and reverse this crisis. Unfortunately, we're not sensing that same sense of urgency from the administration. On the campaign trail, President Trump repeatedly promised action. He said, and I quote: We're going to help. The people that are seriously addicted, we're going to help those people, unquote. But we're 6 months into the administration and the President has still not appointed a drug czar to lead the Office of National Drug Control Policy, nor has the administration produced a National Drug Control Strategy. Instead, what the President has done is propose cutting the programs that are already working. His proposed budget would cut $370 million to the Substance Abuse and Mental Health Services Administration, which provides grants for opioid overdose drugs, mental health, and prevention programs. In the midst of a national emergency, we cannot accept that. The President's efforts to repeal the Affordable Care Act also would have devastating effects on Americans suffering from drug addiction. The latest effort to repeal the ACA would take health insurance away from 2.8 million people with substance abuse disorders. Let me repeat that: 2.8 million. Congress must not let that happen. Additionally, repeal of the Affordable Care Act could also make it difficult for individuals with substance use disorders to find the help they need. Legislation repealing the bill would allow States to waive the ACA requirement that mental health and substance abuse treatment are part of the essential health services. This would leave many of those seeking help without insurance coverage on those areas for the very treatment they desperately need. We're here today to discuss reauthorization of the Office of National Drug Control Policy. This office plays a critical role in coordinating the Federal response to our Nation's drug epidemic. The office manages a budget of more than $370 million and coordinates the related activities of 16 different Federal departments and agencies. ONDCP also administers two Federal grant programs. Communities in my district, for example, have been fortunate to receive assistance for what's called the High Intensity Drug Trafficking Area Program, which provides grants to localities and States and Tribal areas to counter drug trafficking activities. In 2010, we saw a shift to emphasizing public health based services within the National Drug Control Strategy. I look forward to hearing more about the importance of a comprehensive approach to this challenge. Prevention and treatment are important tools working together, as the chairman suggested, in how we approach this. What is also important is ensuring that any national drug control strategy is based on empirical evidence and one that prioritizes results over prior beliefs or ideology. Evidence should always guide public policy, particularly when addressing matters of public health and safety. We've witnessed the perils of failing to follow that prescription in our marijuana policies, and cannot afford to repeat just costly mistakes. This committee held a number of hearings on that topic in the last several years, and each time I noted we have no empirical evidence that justifies marijuana as classified a Schedule I drug. In fact, the U.S. National Institute on Drug Abuse, NIDA, which for years was the sole Federal entity that controlled access to the Federal Government's lone research supplier of marijuana, was unwilling to fund or conduct any Federal research into the question of whether marijuana might have positive benefits. This lack of empirical evidence to support our policy has lead us down a dark path, wherein our national drug policy has provided cover for arresting all too many minority Americans for nonviolent offenses at rates up to eight times those of White Americans, and filling our prisons beyond maximum capacity, scarring them and their families, often for life. We've got to rethink that approach, and it's got to be empirical based. I want to thank our panelists for being here today, Mr. Chairman, for their contributions to the Office of National Drug Control Policy and their personal contributions to this dialogue. And I want to reiterate my commitment to cooperate with you, Mr. Chairman, and our mutual staffs to make sure that we are aggressively addressing this critical issue that is now afflicting our country. Thank you so much. I yield back. Chairman Gowdy. The gentleman from Virginia yields back. We'll hold the record open for 5 legislative days for any members who would like to submit a written statement. I'm going to recognize our witnesses. I will recognize you from my right to left and then introduce you that way and then recognize you for your opening statements. I would tell all the witnesses, your opening statement is part of the record. I am sure that my colleagues have read it. So to the extent you can, keep your opening statement within 5 minutes so the members can have an active dialogue with you. Our first witness is Mr. Richard Baum, Acting Director of the Office of National Drug Control Policy. Next, we have Ms. Diana Maurer, Director of Justice and Law Enforcement Issues at the Government Accountability Office. We have Dr. Humphreys, who is a professor of psychiatry and behavioral sciences at Stanford University. And Mr. Don Flattery, who is an addiction policy advocate and a parent who has been impacted by today's subject matter. We want to welcome all of you, and thank you for being here. Pursuant to committee rules, all witnesses are to be sworn in before they testify. So I would ask you to please rise and lift your right hand. Do you solemnly swear the testimony you're about to give is to be the truth, the whole truth, and nothing but the truth, so help you God? May the record reflect all the witnesses answered in the affirmative. You may sit down. With that, we will recognize Director Baum. WITNESS STATEMENTS STATEMENT OF RICHARD BAUM Mr. Baum. Chairman Gowdy, Ranking Member Connolly, and members of the committee, thank you for inviting me to appear before you today to discuss the activities of the Office of National Drug Control Policy. Mr. Connolly. Is your mic on? Mr. Baum. How's that? Is that better? Mr. Connolly. I think it just might be old age on our behalf. Mr. Baum. Do I need to get real close in there? Mr. Connolly. That's good. Chairman Gowdy. That's good. Mr. Baum. All right. I'm going to start over. Can you restart the clock for me? Chairman Gowdy, Ranking Member Connolly, and members of the committee, thank you for inviting me to appear before you today to discuss the activities of the Office of National Drug Control Policy. It's a tremendous honor for me to be here and to serve as acting director of the agency where I've worked for two decades. At ONDCP, we have a dedicated team of policy experts who are working to address the opioid crisis and the full range of drug threats our country faces. Having the strong support of the President, his administration, and Congress, particularly, this committee, means a great deal to us. Given the state of this crisis, reauthorizing the office charged with responding to it is more important than ever. Thank you for taking this on. We're grateful. As you are all aware, we're in the midst of the worst drug epidemic in U.S. history. In 2015, we lost more than 52,000 people to drug overdose, including more than 33,000 to overdoses involving opioids. The opioid epidemic began with the overprescribing of prescription drugs and has evolved to include heroin, and increasingly, illicit fentanyl. In my time as acting director, I've met with parents who have lost children, visited communities hit hard by this epidemic. When I was in Johnstown, Pennsylvania, students at the University of Pittsburgh, Johnstown, had just found out that a star on the wrestling team had died of an overdose involving fentanyl. It's heartbreaking to hear the stories of lost lives, and we know these are stories you've heard in your districts and all over the country. Most lethal drugs are not made in the U.S., and ONDCP works with Federal and international partners to improve international drug control and dismantle the organizations that traffic these deadly drugs into our communities. Beyond opioids, we also face a rapidly growing threat from cocaine, as well as serious threats from methamphetamine, synthetic drugs, and marijuana. I look forward to discussing these specific drug threats in more detail in the Q&A. ONDCP serves as the lead drug control agency and advisory to the President on drug issues. Our activities include policy development, coordination, and drug budget oversight, as well as targeted grant funding. Our position within the White House provides a platform to build support for proven strategies to address quickly evolving drug threats. ONDCP strongly supports a comprehensive policy approach to address all aspects of the drug problem, supply and demand. Reducing the drug supply is critical to our overall efforts. The U.S. must use every tool available, including working with partner nations on drug crop eradication, land and sea interdiction, and destroying the criminal networks which bring these substances into our country and smuggle illicit proceeds out. Domestic law enforcement, including State and local agencies, play a critical role in reducing drug availability and building cases against trafficking groups. ONDCP also plays a critical role in promoting the science of addiction and evidence-based treatment and breaking the stigma surrounding substance abuse so people will be more likely to seek treatment and to achieve and maintain lifetime recovery. Prevention is a vital component of addressing drug abuse in this country. I've, therefore, made it a priority to reinvigorate a national prevention effort to engage youth in schools and online. This is a critical component for preventing drug use from beginning in the first place. ONDCP is also focused on supporting ways for the criminal justice system to better address addiction within its populations. For many people, engagement with the law is the first opportunity to access treatment services. Whether through pretrial or prearrest diversion to treatment via drug courts or through treatment within correctional settings, it's better for all of us that those who need treatment receive it. As you know, ONDCP writes the President's National Drug Control Strategy, which provides a comprehensive and science- based national approach to reducing the use of illicit drugs and their consequences. This strategy is guided by input from Members of Congress and other stakeholders. The Trump administration envisions an action-oriented strategy, and our efforts to prepare the President's inaugural strategy are underway. And I'm happy to get more into this in the Q&A. One of our greatest strengths is the ability to coordinate drug control activities across the Federal Government and work directly with State, local, Tribal, and international partners to further the administration's drug policy goals. We use our budget oversight authority to prevent duplication and make sure Federal dollars are well spent. We work to lift up innovative programs at the State and local level, such as the Police Assisted Addiction and Recovery Initiative, or PAARI, where police work with public health to connect people with addiction to drug--with treatment for drug addiction. And we coordinate the response to specific drug threats. Our National Heroin Coordination Group and national cocaine group were designed to make us more nimble and approve drug- specific coordination across government, such as developing safe handling instructions for fentanyl so first responders don't experience overdose, and prioritizing efforts to take down dark web marketplaces on the internet for drugs like fentanyl. On July 5, the Department of Justice took down AlphaBay, a primary source of fentanyl. As you're well aware, ONDCP runs two grant programs that work to address the national problem. The HIDTA program facilitates coordination between local law enforcement, State, and Federal officials, and approves antitrafficking operations in each of the 28 HIDTAs. The DFC program provides grants to nearly 700 community-based antidrug coalitions across the country. Before I close, I'd like to acknowledge and thank the Government Accounting Office. We have been through numerous engagements with GAO, and I've found that their recommendations have been extremely helpful to us in our work. We look forward to working with the committee on a reauthorization measure that aligns with the administration's priorities and provides the framework for ONDCP to best address the serious crisis the country faces on drugs. Thank you, Mr. Chairman. [Prepared statement of Mr. Mr. Baum follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Gowdy. Thank you, Director Baum. Ms. Maurer. STATEMENT OF DIANA MAURER Ms. Maurer. Good morning, Chairman Gowdy, Ranking Member Connolly, and other members and staff. I'm pleased to be here today to discuss GAO's recent work on Federal efforts to address illicit drug use. Combatting drug trafficking, drug abuse, and the associated impacts on public health and public safety is costly. The current administration has requested nearly $28 billion for a wide variety of activities involving several Federal agencies. It's a truly multifaceted effort with very different missions in public health, law enforcement, intelligence, education, corrections, and diplomacy, and it needs to be. The problems from illicit drug use in the United States are complex, widespread, and deep-seated. And if there's one thing we've learned over the past several decades, there are no quick or easy fixes. But more significant than the cost and complexity of Federal efforts is the very human, very tragic, and increasingly deadly toll of illicit drugs. According to the CDC, there were over 52,000 deaths from drug overdoses in 2015. That's up more than 40 percent since 2009. It's difficult to grasp numbers like that. 52,000 death in a year means 144 Americans die every day. That's more every 2 days than in all the terrorist attacks in this country since 9/11. There's another way to think about it. The Vietnam Veterans Memorial here in Washington, D.C. has over 58,000 names on it. So one way to visualize the current human impact of illicit drugs is to picture building a memorial of similar size every single year. Given these bleak facts, it's vital that taxpayer dollars to address this problem are well spent, that we're making progress, and that the various agencies are well-coordinated. Those are goals to keep in mind as you consider reauthorization. It's important for ONDCP and the various agencies to have a clear strategy to guide them, goals and measures to know whether they're making progress, and seamless coordination and collaboration. And over the years, ONDCP, to its credit, has focused a great deal of time and attention developing strategies and using performance measures to assess the progress of Federal drug control efforts. The administration is currently updating the National Drug Control Strategy. Since that remains a work in progress, my comments today are based on goals and measures from previous strategies. In 2010, ONDCP issued a series of goals with specific outcomes the Federal Government hoped to achieve by the end of 2015. And as we have previously reported and testified, ONDCP's goals provided a dashboard with meaningful indicators of progress and clear goals. The Federal Government achieved none of the seven overall goals established in 2010. Now, in some key areas, the trend line moved in the opposite direction; things got worse. For example, the number of drug-related deaths increased over 41 percent, rather than decreasing 15 percent as planned. The prevalence of drug use by young adults increased rather than decreased, largely due to increased marijuana use. But there is also important progress in some key areas. There have been substantial reductions in the use of alcohol and tobacco by eighth graders. And the prevalence of drug use by teenagers has also dropped, not enough to meet the goals set in 2010, but certainly an encouraging sign. And preventing drug use is a key part of the overall Federal effort. Last year, the comptroller general convened a diverse group of healthcare, law enforcement, and education experts to discuss, among other things, high priority areas for future prevention efforts. They identified several options, including increasing the use of prevention programs that research has shown to be effective; working to change perceptions of substance abuse; emphasizing that a substance use disorder is a disease that can be treated; reducing the number of prescriptions issued for opioids; supporting community coalitions that include the healthcare, education, and law enforcement sectors; and improving Federal data on drug use. Mr. Chairman, as Congress considers these and other options while debating ONDCP's reauthorization, it's worth reflecting on the deeply ingrained nature of illicit drug use in this country. It's an extremely complex problem that involves millions of people, billions of dollars, and thousands of communities. GAO stands ready to help Congress assess how well ONDCP and the other Federal agencies are doing to reduce the impact of illicit drug use. Thank you for the opportunity to testify this morning, and I look forward to your questions. [Prepared statement of Ms. Maurer follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Gowdy. Thank you, Ms. Maurer. Dr. Humphreys. STATEMENT OF KEITH HUMPHREYS, PH.D. Mr. Humphreys. Chairman Gowdy, Ranking Member Connolly, and members of the committee, thanks for your leadership, and thank you for inviting me to speak to you today. My comments are informed by my 30 years as an addiction researcher and clinician, and also by my service at ONDCP where I was honored to serve in the Bush and Obama administrations. As has been said, we're losing---- Mr. Connolly. Mr. Humphreys, I'm sorry, if we can interrupt. It's very hard to hear you. You need to speak right into it like I'm doing. Mr. Humphreys. Okay. Is this better? Mr. Connolly. Much better. Thank you. Mr. Humphreys. All right. I hope you heard me say thank you for having me here today. Thank you for your leadership. As has been said, we are losing over 50,000 Americans a year. To give my own comparison point, that's more than we lost to AIDS in the worst year of the epidemic. ONDCP was set up actually to respond to the crack cocaine epidemic, but I think a modernized reauthorized ONDCP could be a very powerful force against this new and quite different epidemic. ONDCP can coordinate the Federal policy process. If there's no one writing a national strategy, what happens is Federal agencies, some of them lose interest, not because they don't care, but just because they have a lot to care about at the Federal level. Also, sometimes agencies have competitive programs, duplicative program, or programs that have no evidence of effectiveness. So ONDCP's most important job is to herd the cats in Washington and get a strategy that is unified and effective. You can help them do that job better by giving out some more carrots and sticks. So on the carrot side, providing some money for demonstration projects for ONDCP could help them entice agencies to try new drug policies or new programs. On the carrot side, ONDCP's power to review and decertify budgets could be strengthened so that the Director of ONDCP was the final word on that, rather than usually having to yield to OMB. Related to that, there is a notification requirement in the 2006 reauthorization that says Congress must be notified when there's a decertification. That has made directors very wary of using decertification. It hasn't been used in years. And you might consider dropping that, letting the executive branch work among itself and get on the same page before they come to you with their ideas. Last, I hope you would urge the President to put the ONDCP director position back in the Cabinet. That gives a really strong message to the bureaucracy that we're taking drug policy seriously. Another critical role for ONDCP is to serve as a resource to the White House and to Congress on the role of addiction issues in mainstream healthcare. Just give you an example on that, a very current example. Many people aren't aware that Medicaid is now the lead funder of opioid addiction treatment in this country. So it's important for ONDCP to be a voice to say, if we curtail that program, we, by definition, curtail treatment for this problem. ONDCP would also be helpful with Medicaid and other programs in being the voice for procedures and policies. We have to reduce the likelihood that opioid prescriptions are inappropriate, which is a challenge for all health insurers. ONDCP has been less influential on healthcare policy than it could have been because it was created primarily as a domestic and law enforcement agency, and its staffing, its knowledge base, and its strongest relationships reflect that heritage. Law enforcement is extremely important in drug policy and it always will be. But health policy is also really important, and it might even be more important for the opioid epidemic, which after all, was started not by criminal gangs, it was started in the healthcare system. Congress could support a broader role for ONDCP and healthcare policy by better balancing the focus of the agency's authorization. Just as one crude indicator of what the last authorization asked ONDCP to do, my own count is that the text mentions interdiction 40 times, enforcement 98 times, and healthcare only once. Congress could also mandate a bigger role in the drug policy development process for major healthcare agencies like the CDC, the FDA, and CMS. Congressional guidance regarding ONDCP staffing to ensure they have good in-house health policy expertise could also help. Finally, with Congress's help, ONDCP could improve drug policy through targeted research efforts. To take a prominent example of why this matters, we really do not know how many people are addicted to heroin in this country. The measures just aren't that good. Giving ONDCP a bit of some funding to either conduct research or commission research on critical drug policy questions like that would reap huge rewards for the development of policy and also its evaluation. In closing, I want to emphasize we're in the midst of one of the worst drug epidemics in the history of our Nation. With the right support from you, the White House Office of National Drug Control Policy can lead the government and the country in a coordinated, effective, and lifesaving response to this horrifying epidemic. Thank you for your time, your leadership, and I look forward to your questions. [Prepared statement of Mr. Humphreys follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Gowdy. Thank you, Dr. Humphreys. Mr. Flattery. And all the members would also like to recognize and welcome your wife, who is with you today as well. You're recognized. STATEMENT OF DON FLATTERY Mr. Flattery. I join others in thanking you, Mr. Chairman, Ranking Member Connolly, at least for today, and other members of the committee, for conducting this hearing about reauthorization of the Office of National Drug Control Policy. It's a much needed discussion to ensure the Federal Government is prepared to fight to end the epidemic of prescription drug and heroin addiction the country is facing. And while I strongly support, as an advocate, the activities of ONDCP, my purpose in this discussion today is not to drill down and discuss individual activities in any detail. My name's Don Flattery, and until recently, I lived in Fairfax County, Virginia. I'm a former Federal manager; a recent member of the Virginia Governor's Task Force on Prescription Drug and Heroin Abuse; a policy advisor to the national addiction-fighting nonprofit, the FED UP! Coalition; and I'm an active participant in my newly adopted county of Brunswick, North Carolina's addiction task force. But I'm not here today in any of those roles. I'm addressing the committee solely as a grieving parent, someone who's lost his 26-year-old and only son to an opioid overdose less than 3 years ago. In prior committee hearings, you've heard the appalling statistics about the explosion of opioid prescriptions addiction rates over overdose deaths. I'm intimately aware and familiar with them and I'll not repeat them here, but those discussions are often far too clinical. As you, Federal officials, elected officials, State officials, and public health practitioners deliberate and consider solutions, it is far too easy to become detached. As you proceed, I implore you to recall the personal impacts. We are not just speaking about shocking, obtuse statistics. We're speaking about my son, your daughter, and our neighbors. They're real people with real lives, suffering from a disease, and their losses are the face of the epidemic that we must stop. Allow me to briefly share my son's story. On Labor Day weekend 2014, my family lost my 26-year-old Kevin to an opioid overdose. Like so many swallowed by this crisis, Kevin enjoyed the blessings of a typical suburban upbringing, attending private schools, participating in youth sports and high school athletics. He came from a loving two-parent home and leading the quintessential middle class life, enjoying all of life's and God's blessings. He was a good student and was a graduate of the local all male prep school, Gonzaga, right here in Washington, D.C., and later the University of Virginia, where he actively participated in student and fraternity life. Kevin came to his addiction as a working adult while pursuing his talent and passion working in the film industry in Hollywood and New York City. He'd been exposed to opioids as a teen after an injury, and he told me himself that he thought nothing of them. Like so many, he underestimated them. While working, he began self-medicating issues with anxiety and depression with the widely available opioid prescription drug, OxyContin, which is a common story, as many struggling with coincident mental health issues develop addiction problems. He quickly became dependent and then addicted. He returned home to Virginia in the fall of 2013 to his family seeking treatment and support. Like many struggling in search of treatment, he tried a wide variety of pathways, including detoxification, medication-assisted programs, and an outrageously expensive 28-day abstinence only residential program. Some of these were covered by insurance, but others were covered out of pocket. But like others in pursuit of recovery, he experienced the painful and very common process of seeming progress followed by relapse. Days before he was to start a program of the medically assisted treatment drug, naltrexone, he used again and he did not recover. The short bio description I just gave you is an example of how the scourge of the opioid addiction epidemic before us today has no stereotypical victim. It's affecting people of all walks of life, all income levels, and all backgrounds. This epidemic--and make no mistake, this is an epidemic--and my son's addiction do not respect income, social status, or intelligence. That's what epidemics do. That point bears repeating in every hearing this committee and others conduct which touch upon this health crisis. Since my son's loss, I've learned a great deal about the disease of addiction, the current epidemic, and it's underlying causes, and painfully, for me and my wife, some evidence-based treatment opportunities that offer hope, but now only for others. From the perspective of an impacted parent, as a citizen, and as an advocate, I would like to add my voice to thousands traveling the same journey about some imperatives needed to stem the tide of the epidemic. The first is the primary topic of this very hearing. The need for a strong well-resourced and effective ONDCP has never been more important. A policy office directly tied to the Office of the President not only sends a message to the public about the importance of effective drug policy, but it also ensures more effective development of integrated, cross-Federal Government programs and policies. ONDCP plays an essential role in being an integrator and a coordinator for the widely disparate addiction-fighting efforts of HHS, SAMHSA, NIDA, CDC, the FDA, as well as programs in the VA, DOD, Indian Health Service, and a wide variety of law enforcement agencies. Interagency discussions and collaborations will be ineffective without the singular collaboration entity empowered to work across stovepiped efforts and programs. The second imperative is continuous coverage of addiction treatment. Access to medication-assisted treatment already remains elusive for far too many patients. Changes to the Nation's healthcare system that remove mental health and substance use disorder coverage as an essential benefit will be a disaster for many, including those like my son, seeking such help. We must find ways to expand, not limit, access to addiction fighting medications, and ensure insurance companies and providers do so at a reasonable cost. Mr. Chairman and members of the committee, thank you again for addressing the need for an effective ONDCP as part of the Federal Government's response. We need to ensure Federal entities do their part to appropriately protect our loved ones and the public health. Americans suffering from this scourge deserve no less. Thank you. [Prepared statement of Mr. Flattery follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Gowdy. Thank you, Mr. Flattery. We'll now recognize the gentleman from Oklahoma, Mr. Russell, for his questions. Mr. Russell. Thank you, Mr. Chairman. And thank you, panel, for being here today. I agree with all of the statements that have been made. And, Mr. Flattery, you know, you certainly bring--you and your wife bring this issue--put a personal face on it. It affects so many. I have also seen the devastating effects of overmedication in trying to treat veterans, as a combat veteran myself, and seeing a number of folks as they try to come home. It seems to be the simple thing is just to give warriors a bag of cocktail-type of medications, and then now they're on addictions. And then we wonder why the returning veteran came home and, quote, committed suicide, when it may have been the direct effects of overmedication and addiction. It seems to me, Mr. Chairman, that we all bear responsibility for this. It was Congress that made the decision to relax the laws that allowed more over-the-counter direct access to what I consider to be legalized heroin. So I guess my first question, and whoever would like to comment, but we'll start with you, Mr. Baum. And thank you for your dedicated years of service in dealing with difficult issues. What legislatively could we do? We let the genie out of this bottle by relaxing the access. You know, I go home, even in the great State of Oklahoma, you'll see these pain and injury centers everywhere. Somebody can walk in and the next thing you know, some physician may sign off and, you know, you can go off with a bag of pills. What legislatively would you like to see done with the decades of retrospect and how we got here? Mr. Baum. Congressman, thank you for your question. There are a lot of things that we can do more of. And, you know, I guess I would start by saying, when we're in a crisis and so many people are dying, we need to do more of everything. So I would love to see tighter restrictions on use of the narcotic analgesics. I don't think the evidence is there to have these substances used as a default for chronic prescriptions. You know, once--the data is very clear. Once someone is using these substances for more than 5 days, their addiction rates go up dramatically. So tighter controls on that. Certainly, resources for prevention, treatment, and medication-assisted treatment. We have lots of very clear evidence that people do well on medication-assisted treatment. Everyone should be offered it. If you look at the data, only about a third of the people with a diagnosed opioid use disorder actually now have access to treatment. And let me say one last thing, and maybe turn it over to my colleagues, is that 80 percent of people with a substance use disorder do not come forward for treatment. So we don't just need to get better high-quality treatment to those who are on a waiting list; we need to go out and find the people out there and bring them in and control them and encourage them to get the help that they need. Mr. Russell. Thank you, sir. And anyone else who would care to comment. Mr. Humphreys. Congressman, I just want to give you an important piece of information about how much prescription opioids Americans consume. On a per capita basis, we are the world leader by an enormous margin, six times what European countries prescribe. We could cut prescribing by 40 percent and we would still be the world leader in opioid prescribing. So that is the biggest wheel. There are many good policies, treatment, prescription monitoring, and so forth, but that's the fundamental thing, is we're just prescribing way too much. Mr. Russell. Okay. Ms. Maurer? Ms. Maurer. Yeah. When the comptroller general convened the panel of experts last year, that was one of the topics of discussion precisely, what you just asked about. And there were some common themes that came across from that body of experts, and one was exactly what Dr. Humphreys just talked about. First and foremost was prescribe fewer opiate medications. But hand in hand with that was also a theme of providing additional education to providers. The CDC has some guidelines--some recently updated guidelines that apparently the word has not gotten out fully on those things. Prescription drug monitoring programs are an important part of this. And as well as on the law enforcement side, continuing aggressive investigation and prosecution of pill mills. Mr. Russell. Thank you. Mr. Flattery. If I may, just to add to that. The recent activities have been somewhat successful in reducing the number of prescriptions. The U.S. with 5 percent of the world's population is consuming 80 percent of the world's opioids. Voluntary prescribing guidelines, development of PDMP systems are having an impact. Last year, prescriptions in this country declined to over 220 million prescriptions. That's still enough for every American to have their own prescription bottle for 30 days. These prescription drugs are continuing to flood our communities, our workplaces, our schools, and our medicine cabinets, making them available for medical overuse and for abuse. You asked the core question, what can you do legislatively. We need our State partners, because they are responsible for managing the practice of medicine, and we need them, and they are, we are beginning to see some progress in State capitals addressing the overprescription of opioid drugs. Mr. Russell. Thank you. And thank you, Mr. Chairman, for you indulgence. I yield back. Chairman Gowdy. The gentleman yields back. The gentleman from Virginia is recognized. Mr. Connolly. I thank the chair. And again, I thank the panel for their very cogent testimony. Mr. Baum, this is a hearing on the reauthorization of your office. Has the administration or has your office submitted a draft reauthorization bill to the Congress? Mr. Baum. Mr. Connolly, we have not, but we do have some considered thoughts and would be happy to discuss some of those---- Mr. Connolly. Well, we need a reauthorization bill from somebody, even if we decide to go a different direction. Any idea when it might be submitted? I mean, the chairman pointed out, I think the last reauthorization was 2006, so it's grown stale. We heard Dr. Humphreys point out, you started out originally as a crack cocaine focus, things have changed. Reauthorization's got to take cognizance to that. We want to be supportive, but we've got to have some kind of timeframe in which you're going to-- not you personally--the office and the administration are going to interact with Congress that ultimately has to do the reauthorization. Any idea when we might see a draft? Mr. Baum. I don't want to give you a timeline, but I can tell you this. I've studied the issue very closely. We know what we need to do. Mr. Connolly. Okay. Mr. Baum. We can put together a reauthorization bill and work with our partners in the administration and get something to the Congress relatively rapidly. So I look forward to the-- -- Mr. Connolly. I don't presume to speak for the committee, but I think as you can hear, on a bipartisan basis, we're seized with this mission and urgency, and I hope you'll take it back. We want to see a reauthorization. We're happy to help, but--okay. Mr. Baum. We want to see it too. We're eager to move out on it. Mr. Connolly. Likewise, we need a strategy. Any idea when a strategy will be submitted to the Congress? Mr. Baum. I have a very precise idea. Mr. Connolly. Okay. Mr. Baum. I'd be happy to discuss that, and I know Mr. Gowdy raised it as well. We're developing a strategy now. You know, I do want to say that I take the deadlines that--the statutory deadlines extremely seriously, and I know what the deadline is, February 1. In the Trump administration we are developing a strategy, we have a draft, we're consulting both formally in terms of letters to Members of Congress. I've been traveling, holding meetings. I'm holding interagency meetings. We are working a conference of strategy---- Mr. Connolly. Again, I'll stipulate to all that. Look, I only have 5 minutes. Mr. Baum. Yeah, sure. Mr. Connolly. When can we see it? Mr. Baum. The deadline is February 1 of next year, and there is an issue with--we are required to wait until the President's budget comes out, but sometimes it is a few weeks after. But early next year, you'll have a comprehensive drug strategy from the administration hovering the entire scope of the issues. Mr. Connolly. All right. Well, let me invite you, even in draft form, if you can, to start, because we want to be partners. And the urgency of the subject, you know, I think demands executive and legislative branch cooperate as much as we can. So that strategy, you know, I hope will reflect the realities so many Members are experiencing in their respective districts. And so we'd be glad to work with you, but we've got to have some kind of draft to start with. Likewise, what about the appointment of a director? And I think you're perfect, you're my constituent. How can we do any better than you? But we still don't have--it's been 6 months, and you're not alone, there are a lot of vacancies in the executive branch, but this one's pretty critical. Any idea when we might hear a name floated, let alone actually someone nominated? Mr. Baum. Well, thank you for that strong endorsement. I appreciate that. Mr. Connolly. I won't help you with Donald Trump, but---- Mr. Baum. I'm---- Mr. Connolly. I can bad mouth you if that would help. Mr. Baum. You know---- Mr. Connolly. Donald, this man's a loser. Don't do it. Mr. Baum. Can I take back my time then? Mr. Connolly. Yeah, yeah, yeah. It's actually my time, but go ahead. Mr. Baum. We appreciate the thought. We know that they're working on filling these positions. It's a critical position, and as soon as we have something to report, you'll be the first to know. Mr. Connolly. Well, that's so comforting. All right. Thank you. Mr. Flattery, I want to go back to your testimony. And thank you so much for being willing to share. Thank you to your wife for coming up here. You mentioned your--well, first of all, and I don't--if the chair will just indulge me in this line of questioning for a little bit to draw out a little bit more the story of Kevin. So your son wasn't hanging around with the wrong kind of crowd that was into drugs and that's how he ran into trouble. That's not how his problem began, is it? Mr. Flattery. No, it is not. My son did not, as many unfortunate young people do, he did not surrender his youth, he did not turn his back on his activities and friends and school work. He became addicted as a working adult pursuing what he was passionate about. Mr. Connolly. But he became addicted. What triggered the need--or his perceived need for the use of an opioid? Mr. Flattery. In my son's case, my wife and I believe that he began medicating issues with--self-medicating issues with a widely available drug. Mr. Connolly. No. But why? Mr. Flattery. Because like many people who develop addiction problems, they often have coincident psychosocial issues that have to be dealt with, and that's why pairing of mental health services and addiction treatment services is so critical. Mr. Connolly. In his case, he was in New York trying--he was an aspiring film maker? Mr. Flattery. At that time, he was in Hollywood. Mr. Connolly. In Hollywood. All right. Mr. Flattery. And he was exposed to widely available OxyContin and very inexpensive OxyContin. Mr. Connolly. He came home? Mr. Flattery. He did. Mr. Connolly. And he, from your point of view, made a really good-faith effort to try to lick this, correct? Mr. Flattery. Yeah. Sort of adding to our own personal tragedy, our son was completely cooperative in trying to pursue treatment. He recognized that he had fallen into the rabbit hole and he was in over his head. He was seeking our support. He tried a number of pathways. And they're common pathways. Detox, intensive outpatient support from Inova Fairfax Hospital. He was on a regimen of buprenorphine, also known as Suboxone, and he still struggled with it. He attended peer support through AA and NA. But at one point, he same to us and said, you know, I just--he began to manipulate his own Suboxone, because it's a self-administered medication. And he said, you know, I think I would like to try a residential treatment program. And I do have issues with my son's experience in residential treatment. Many, not all, residential treatment programs often use a detoxification, and then couple either cognitive behavioral talk therapy during the 30-day stay with what I consider to be reformulated step program dogma, which is available for free in church basements all over the country. Those programs, at least the program that my son encountered, are very expensive, $28,000 to $30,000 a year. Those types of programs, I think, are emblematic of why our treatment system is broken. Many families will do anything in their power to get help for their loved one, as we would. And many families are bankrupting themselves sending them to such facilities that then after the 30-day stay, release them to the wild. And they often are treating the people who attend, not as patients, but as customers. And the disease of addiction is a chronic, reoccurring issue that has to be dealt with over a long period of time. And in my son's case, he was not ready to be released to the wild after 30 days. It's not a magic fix. And our treatment system has to be reengineered to provide long-term care for a chronic condition, and that's, in my estimation, where my son's journey broke down. Mr. Connolly. Thank you. Mr. Chairman, you've been gracious. I thank you. Chairman Gowdy. The gentleman yields back. The gentleman from Tennessee, Dr. DesJarlais. Mr. DesJarlais. Thank you, Chairman. And I thank the witnesses today for appearing on this extremely important topic. Mr. Flattery, you and your wife have become way more involved in this issue than you probably ever hoped to since the loss of your son. You'd mentioned a couple of times here to Mr. Connolly and in your opening statement about the ease of access of opioids, specifically OxyContin. Can you explain a little further what your understanding is of why these are so easy to get and why they're so inexpensive? Mr. Flattery. Well, I'll first start with the basic essence of the anatomy of this epidemic. This is, as Mr. Humphreys indicated, this wasn't started by drug dealers who had built a business model around providing illicit drugs. This had its origins in the medical community, and I believe you are a medical practitioner yourself and understand that. In an attempt to be compassionate in the treating of pain, American physicians use their prescription pad. American physicians also have a deficiency in prior training on proper pain management and addiction management. There isn't even a whole discipline built yet around addiction management in medical schools. So in an attempt to provide compassionate care, American physicians are implicated in the overuse of opioid drugs for all manner of pain conditions for which they were never intended. They started out as a drug that was to address terminal cancer pain and recovery from acute injuries, and it drifted into the use of opioid drugs for migraines, arthritis, indiscriminate lower back pain. In the dental community, for wisdom tooth extraction. And they not only were being overprescribed, they were being prescribed in quantities that were completely unnecessary for the treatment of an acute condition. And as Mr. Baum indicated, long-term use of opioid drugs lead to addiction. Now, you asked the question about why so ubiquitous. And the answer is, in 2013, we hit the peak year in the U.S. with over 259 million prescriptions. That's a number in the billions of individual doses. And those drugs are flooding communities and workplaces, and they're just widely available, and they're available for potential misuse. So they're available at low cost on the street. Mr. DesJarlais. Okay. Mr. Baum, is there currently any legal requirement for prescribers, physicians, nurse practitioners, to fully educate their patients on, not only the harms addictive properties of these medications, but also to educate them on the dangers and illegality of sharing these medications with other people? Mr. Baum. Thank you for the question. There is no requirement from mandatory prescriber education, and frankly, I am very concerned about that. I know in the previous administration, there was discussion about increasing voluntary prescriber education. But looking at the progress, I don't think it's been nearly enough. And I think it's something that we ought to talk about making it mandatory. To make sure at least those prescribers that are putting these very, very powerful drugs in the hands of our citizens, spend a few hours learning about the risks and about addiction, I think would be important, and it's something that we should talk about. Mr. DesJarlais. I think it's, yeah, probably more than something we should talk about. As a former physician and current holder of a DEA license, I know that I would make it a point to educate my patients on the power of these drugs. But, also, I think there's responsibility among the patients to know that it should be illegal to share these drugs. I have a license, went to medical school to prescribe them, but patients often will just share it with family and friends thinking that it's okay. That should be a crime. And it probably is, but it's not enforced. And if one of the problems is overprescribing, that needs to be stopped. And physicians and medical students and all prescribers should be educated in medical school on this issue. Because of the scope of this problem, the time is ripe to do that. But, also, I think that it is a patient's responsibility to properly handle these medications, and there should be laws and documents that a patient should sign when they pick up this prescription, either from the pharmacy or when physicians prescribe it. Would you be willing to look at that as an option? Mr. Baum. Yeah, I'm absolutely willing to look at it. But I really think the major responsibility is with the prescribers. When you have an injured kid that you're taking to the doctor and the doctor gives you your prescription to take pills for 30 days or 60 days and you get your bottle of bills with the directions, the tendency is to follow the directions, and now we're putting it on parents to ask the doctor, hey, should my-- does my kid really need to take this for 30 days for a wisdom tooth extraction. And I think it should be the other way. The doctors are the experts. They're the one in the white coats. They're the ones with the responsibility to think about the powerful medications they're putting in the hands of our citizens. Mr. DesJarlais. And I'll promise you that the vast majority of all doctors feel the same way. They don't want to harm patients with these medications. They don't want to prescribe irresponsibly. They are always bad actors, and that's who we need to focus on. I think that that door swings both ways. Physicians definitely should take the brunt of the responsibility. I also think that law enforcement should focus on people who share or sell these medications, because as a physician, that was always a concern of mine. If I was treating someone with chronic pain or even cancer, you just assume that those people are taking the prescriptions properly. That's not always the case. And I have all kinds of stories where I found out people were being put in very vulnerable situations by family members to get these prescriptions so they could go out and sell them, and so they were forced to lie to me. I didn't know I was doing the wrong thing, and I know other physicians are in the same situation where they get tricked or duped into thinking people have critical problems or illnesses. And so I do think the enforcement side of that needs to be ramped up as well, but there's a dual responsibility. And the bottom line is we have a huge number of people dying every year, and it's not time to think about what we should do, we should be doing it. And I'm happy to work with you further on this issue. And thanks to the chairman for giving me the additional time. I yield back. Chairman Gowdy. The gentleman from Tennessee yields back. The gentlelady from the District of Columbia is recognized. Ms. Norton. Thank you very much, Mr. Chairman. And I want to first thank you for this hearing. It's a very timely hearing. And I appreciate the bipartisan way in which this hearing is being held. This is an across-the-board problem. Already I've heard ideas, including from my colleague on the other side, as to the kinds of things we need to be thinking about, and for reauthorization. I thought the President had begun in a bipartisan way himself when early on he said he thought that we should--and here I'm quoting him, show great compassion about the opioid epidemic. And then the Office of Management and Budget virtually abolished your agency with a 95 percent cut. And here is where bipartisanship mattered. There was an outcry on both sides of the aisle, and I think in the only--or one of the few circumstances where I have seen the OMB take back its mark, it did. And now I understand only a 5 percent cut. And, Mr. Chairman, could I ask that the letter from the ranking member, Elijah Cummings, and from Representative Johnson, a Republican from Ohio, was signed by 75 members asking that this cut be reversed. It worked. And I ask that that may be made part of the record. Mr. Chairman, is that a part of the record? Mr. DesJarlais. [Presiding.] Without objection. Ms. Norton. Thank you, sir. First, let me mention the statement by Mr. Connolly. It was kind of a very telling critique of current marijuana policy. We all know, I don't care what side of the aisle you sit on, that marijuana is, per se, legal in the United States, certainly by people younger than anyone on these panels, other than--younger than 40, let me say, to be gracious. Yet Congress has prohibited the District of Columbia from using its local funds to tax and regulate marijuana, tried to keep the District from indeed making possession of only 2 ounces legal, but Congress didn't know how to write an appropriation rider that would do that effectively. So here is what we have. The unintended consequences of no regulation, no taxation, as eight States do, but you can possess marijuana. Ms. Norton. So what we've done in the District of Columbia is we have expanded the underground market for marijuana. Indeed, it's nicknamed in the District the drug dealer protection act. And The Washington Post actually identified a marijuana dealer, and he said it was a license for me to print money. Now, there are members of this committee who are from some of the eight States that have legalized marijuana. They are Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Washington State, and Washington, D.C. My question for Mr. Baum is if D.C., if the District of Columbia, could tax and regulate marijuana, would that have the effect of at least partially undermining the illegal marketplace for marijuana in this city? Mr. Baum. Well, I thank you, Congresswoman, for the question. I have to say, I'm a Federal official. Marijuana is a Schedule I illegal substance in the country. Ms. Norton. And I understand that, and I have very limited time. I'm trying to find cause and effect. You've seen what's happened in the other eight States. And I'm simply asking, if you make it legal, if everybody is using it anyway, as is surely the case for younger people---- Mr. Baum. It's not the---- Ms. Norton. --would that make it less likely that you go to an underground peddler? Mr. Baum. Ma'am, respectfully, I don't believe that. It's a harmful substance. Just because it's not killing people the way fentanyl---- Ms. Norton. I'm talking about how you buy it, sir. Mr. Baum. Yeah. Everyone isn't using it, you know. And we have our--I'm concerned about young people in this country and---- Ms. Norton. All right. Let me ask you this. If you're concerned about young people, would you be concerned that the District of Columbia can't regulate marijuana so as to keep it out of the hands of people under 18, for example? Would that be a concern of yours? If, in fact, you're going to possess--if a jurisdiction is going to possess marijuana, should it not at least have the opportunity to keep marijuana out of the hands of children? Mr. Baum. I worry that making a substance widely available and legal increases acceptance of it and increases use among youth. And I think we need to look very closely at what's happening in Colorado and the other States to see if marijuana use especially---- Ms. Norton. Can I ask if you are doing that? We would very much like you to do that. What are you doing as to the States that have already legalized marijuana? Are you giving us any feedback so that we'll know what to do when the time comes for reauthorization? Chairman Gowdy. [Presiding.] The gentlelady's time has expired, but you may answer her question. Mr. Baum. We did have a Federal team go out to Colorado and talk to officials across the spectrum, and we're trying to learn about what's happening. I have to say, I'm concerned about this commercialized model of widespread availability of marijuana and very limited controls of marijuana being grown on public lands, of the involvement of cartels in Colorado in some of the marijuana production. I think there are a lot of challenges, and I think it's something we need to really think about whether we want to make a substance that is harmful more available to our citizens. Ms. Norton. Thank you, Mr. Chairman. Chairman Gowdy. The gentlelady yields back. The gentleman from Montana is recognized. Mr. Gianforte. Thank you, Mr. Chairman. And thank you for the panel for your testimony. This is a critically important issue. And, Mr. and Mrs. Flattery, thank you for putting a personal face on this epidemic we have here. As I travel, you know, I hear repeatedly the impact of drug addiction on skyrocketing kids in foster care, crime, domestic violence. As I talk to law enforcement, there are so many--in addition to the personal tragedies that we've heard today, so this is very appropriate we have this conversation. And I also am looking for solutions and seek your advice. I would be curious--we have 50 States where we look at solutions. I'm curious to hear from the panel of any particular examples where States have taken action that have had positive impact on this issue, and just so that we can learn to look at whether or not some of those things make sense at a national level. Mr. Humphreys. Thank you, Congressman. I'll give you two State policies that show evidence of good effect. One is, which has been done in Oklahoma, is called reimbursement lock-in. And what this is, is that if you are covered by an insurance program and you have three, four, five, six, seven providers writing you prescriptions, the insurer, say Medicaid, will tell you, look, you can get this prescription, but you have only one doctor. And if that person is doctor shopping or dealing on the side, then they're constrained. But if they're a legitimate paying patient, they still have one doctor. So that's reimbursement lock-in. Second one are prescription drug monitoring programs. These vary in quality around the country. Some are easy to use, some are hard to use, but the best ones allow a physician to know, before they write that prescription, is this person getting lots of prescriptions other places. It also can be used by the State to see, is there a particular provider who has really suspicious prescribing? When those programs are well resourced, they reduce overdose deaths. Those should both be used everywhere in my---- Mr. Gianforte. So in that particular case, in Oklahoma, how is that actually accomplished? Mr. Humphreys. It's done through Medicaid. So the Medicaid set up a rule, which they have the power to do as a payer, and said, you know, if you get multiple opioid prescriptions from different providers on Medicaid, you have to pick--one of those doctors is going to be your doctor, period. And they're all going to have to come there. And it's an administrative decision that a Medicaid director can make. Mr. Gianforte. Okay. And open it up to the rest of the panel. Are there other examples you've seen in States that have been effective? Mr. Baum. Thank you, Congressman. And I hope to be coming out to Montana. Senator Daines invited us out there, so hopefully---- Mr. Gianforte. You're welcome. We have room for you. Mr. Baum. So I did want to just mention, you know, police and law enforcement around this country, they really understand this problem very well. And they've been innovating across this country, especially in the States that are hard hit. And I think that sometimes we oversimplify. But, you know, there are drug traffickers, drug dealers, and major violent criminals, and those people need to go to prison for their crimes. But there are also people that their only offense is using and purchasing drugs, and many of those people can be diverted to treatment. And there's a lot of innovation. I mentioned in my testimony the police-assisted addiction program where police are actually taking people in, opening up their police station 24 hours. If you want to come in for treatment and you don't have any serious trafficking or criminal offense, they will do a--an interview with them and consult with a health worker, and they'll put them in the car and drive them right to treatment. And I think--you know, police are very smart and flexible, and getting the people in the treatment who need treatment is something that they are facilitating across the country. Fire departments are doing it as well. You know, you look at the people in our communities that operate 24 hours a day, police, fire, crisis intervention, they are really stepping up and are a critical part of the solution all across the country. Mr. Gianforte. And, Mr. Baum, where is that particular program being run? Mr. Baum. Yeah. It started in western Massachusetts, and my office could give you more information, but now it's in 250 places all across the country. Tremendous leadership by police chiefs and sheriffs who are stepping up to deal with this problem. Mr. Gianforte. Okay. Ms. Maurer. Just real quickly to echo what Mr. Baum was just discussing, that was one of the main themes of the comptroller general's panel last year, was the real importance of having these community networks at the local level that bring together law enforcement, they bring together public health, they bring together the education sector--our work last year was focused on prevention--but can have real benefits across the board with all different aspects of the illicit drug problems. Mr. Gianforte. Okay. Mr. Flattery. If I may, to sort of add on to the notion that we need to continue to support diversion to treatment in lieu of incarceration, one of the barriers to being effective in doing that is we need a Nation's reengineered treatment system. You cannot divert someone to treatment if in rural areas of many States there is no effective treatment to divert them to. It's an unnecessary and excessive burden to place on law enforcement. And there are a number of noteworthy programs around the country to pursue that, but until and unless we reengineer our treatment system, we're only going to have minimal effect. And then another follow-on, you had asked, and Mr. Humphreys pointed out, a number of places where we're having some impact on less in prescribing, the original development of voluntary opioid-prescribing guidelines for chronic pain that CDC developed are being mimicked and adopted in the States. The regulation of medicine occurs at the State, not here in this panel, and we are seeing a number of States try and expand the use of prescribing guidelines throughout the practice of medicine in their States, and not only in just ER settings, and that's where they first started, we need them to be applied in general practice settings where 60 percent of opioid drugs are being prescribed. Mr. Gianforte. Thank you. Thank you, Mr. Flattery. And I yield back. Chairman Gowdy. The gentleman yields back. The gentleman from Missouri is recognized. Mr. Clay. Thank you, Mr. Chairman. And I thank the witnesses also for participating in this hearing today. On May 10, 2017, Attorney General Jeff Sessions issued a memorandum instructing Federal prosecutors to, quote, charge and pursue the most serious, readily provable offense, including mandatory minimum sentences, for drug crimes. The Sessions sentencing memo marked a reversal from Attorney General Eric Holder's Smart on Crime initiative, which sought to move away from mandatory minimum drug sentences and, instead, focus Federal resources on the most dangerous criminals in complex cases. AG Sessions appears to be trying to reinstate the harsh and indiscriminate use of mandatory minimum from the failed war on drugs. Dr. Humphreys, do you think that a strict mandatory minimum policy will help us make progress in curbing the destruction caused by the opioid crisis? Mr. Humphreys. Thank you for that question, Congressman. I do not think that's the case. What I--I work a lot with States. I travel a lot. And what I see all around the country, South Carolina, Texas, South Dakota, California, Utah, is bipartisan coalition to move away from mass incarceration in the way we handled drug problems, basically, in the 1980s and 1990s. And the one place that hasn't sunk in as a perspective, I think, is actually in Washington. I think the States are out front on that. There's strong bipartisan agreement. It's better to treat people than lock them up. You know, there are some horrible actors out there who are doing terrible things, but they are a small part of who gets swept up, generally, in drug enforcement, and we should actually, as acting Director Baum said, be trying to, you know, restore everyone we can. Many of these people are just low- level people who are addicted, and they're much better handled in the health system, not by giving them a, you know, 10-year stint in a prison. Mr. Clay. Yeah. And in response to Mr. Sessions' memorandum, Republican Senator Rand Paul wrote, and I quote, ``The AG's new guidelines, a reversal of a policy that was working, will accentuate the injustice in our criminal justice system. We should be treating our Nation's drug epidemic for what it is: a public health crisis, not an excuse to send people to prison and turn a mistake into a tragedy.'' Dr. Humphreys, do you agree with Senator Paul? Mr. Humphreys. I do agree with the Senator that this is a public health--addiction is a public health crisis. And it is, as has been said by Mr. Flattery, a--it is a chronic medical illness. We should be taking care of it in the treatment system. And, again, I understand that there are terrible drug traffickers who are violent and terrorize communities, and I have no sympathy for them at all. But a huge number of people at the low end of the drug trade are people who themselves have drug problems, and we should be looking at them as people we can try to restore through the treatment system or through collaboration, drug courts being an excellent model. There are other models of probation with what the criminal justice is trying to do is not punish people forever, put them away in a cell forever, but instead, try to restore them to health by working with the treatment system. Mr. Clay. Mr. Baum, is your philosophy in line with what we just heard from Mr. Humphreys? Mr. Baum. Well, the way I would put it, Congressman, is that every case is different. And in the Federal system, we see primarily significant drug traffickers and the violent criminals. And if you're a significant drug trafficker or a violent criminal, you run a network that's bringing illicit narcotics into our country, breaking our laws, and putting the health of our citizens at risk, I think you do deserve a significant sentence. But I also agree that we need to sort carefully the people that come into the system. And there are many people whose only offense is buying and using drugs. And those people that are drug dependent and not involved in running significant trafficking organizations, those people absolutely should be diverted into treatment, into drug courts, into alternative sentences. So I think that sometimes folks lose track that the Federal system is really charged with the trafficking issues, the major criminal groups. It's really State and local governments that are responsible for dealing with local drug dealing and drug users that may commit mild/minor offenses. So we really have to learn to tell the difference and treat differently those with different criminal records and criminal backgrounds. Mr. Clay. I thank you for your response. And I yield back, Mr. Chairman. Chairman Gowdy. The gentleman yields back. The gentleman from Wisconsin. Mr. Grothman. Thank you. It's been a while since I traveled outside the country, I think about 14 years. But the last time I went outside the country, I went to Taiwan, and they don't seem to have this huge drug problem that we do in this country. And at least in my State, I believe, I might be wrong, but I believe more people die of opiate abuse every year than murders and car accidents combined. Certainly, in most counties that's true. It's just horrible. Are any of you familiar with the type of sentencing that we have in countries which don't have these--like Taiwan, that don't have these huge numbers of people dying from opiate abuse? Mr. Baum, do you know what they do in other countries? Mr. Baum. Yeah. I think, you know, because of the incredible overprescribing we've had in this country for two decades, our problem is like no other. Canada is experiencing some of the similar problems that we have, but there's no other country that hands out these dangerous, addictive narcotic analgesics the way we do. Mr. Grothman. There's no question. For years--I'll have to write books about the horrible things our medical professionals did the last 15 years. I'm told it's getting better. But does anybody know, if you are caught with enough heroin, that you're caught with heroin in other countries that don't have these problems, what type of prison sentences are handed out? Mr. Baum. The nations in Asia tend to have very strict penalties and also very strong messaging about drug use. The U.S. problem is different. And I would simply say, in the U.S., we need to get back, there's a lot we need to do on the prescription drug problem but also on prevention, because we need to get a very strong and consistent message out to our youth about the incredible risk they face when using drugs. Especially with fentanyl contaminating our drug supply, drug use is a very risky behavior, and we really need to prevent and delay--delay and prevent, if we can, initiation of drug use, especially for people, our young people, where they're still growing, their body is still growing. It's very risky behavior for young people. Mr. Grothman. Okay. We have four people here. Does anybody know what type of drug sentences are handed out in countries like Taiwan that don't have an opiate--big opiate problem? Nobody knows? Nobody has checked into this? Mr. Humphreys. I have certainly been to Taiwan and other countries like it. They have very, very tough criminal justice sentencing. Mr. Grothman. Well, both you and Mr. Baum said it's very, very tough. What does very, very tough mean? If you---- Mr. Humphreys. The death penalty for dealers, even for low- level dealers. There's places where even with possession, a small amount of possession, you can end up doing a really long time in prison. But, of course, we have put an awful lot of people in prison in this country. It's not as if we haven't tried that route. And I think we are different than those more cohesive, smaller societies, more freedom-loving society, a more capitalistic society, and also a healthcare system that is out of control on the prescriptions. Mr. Grothman. I'm against capital punishment across the board. But just interesting how other countries deal with it. Mr. Humphreys, are all people who use opiates or maybe wind up dying of opiates, are they all addicts? Mr. Humphreys. No, sir, they are not. These are valuable medications, when used properly and safely, that people use them, benefit from them, and then do not get addicted. It is not everybody. Mr. Grothman. What percentage of people who die of opiate abuse do you think are addicts? Mr. Humphreys. Of the people who die of abuse, I would say most of them are. There's occasionally people who have essentially, if I can say, like an accidental exposure, like a kid goes to a party and gets an Oxy they've never had before, has it with a lot of alcohol and dies. But most of the people who are showing up in overdose statistics have been using for awhile and are addicted. Mr. Grothman. I'll tell you what goes on in my area, and I'd like you to comment on it. In my area, we are told that the opiates are frequently purchased from a dealer in Milwaukee County, and then the opiates are brought back to Fond du Lac County or Ozaukee County or more rural points north. And the thing that frustrates local law enforcement is they feel, because Milwaukee County is kind of a liberal county, that, well, if they--if people are caught selling drugs in these more northern counties where there are, you know, a little stricter judges, they are strongly deterred from selling drugs again. But in Milwaukee County and more liberal counties, they get a slap on the wrist. And I was under the impression that maybe if we forced liberal counties to put mandatory minimums on, maybe it would deter some of these sellers that right now only get a slap on the wrist. Would you comment on that? Mr. Humphreys. Yeah. I mean, low-level dealers and many people who have drug problems---- Mr. Grothman. Not necessarily low level, but go ahead. Mr. Humphreys. Okay. Yeah. I'd be happy to talk to you at length more than we have time here for, Congressman, but I don't believe that the really long sentences motivate that population because they don't think that way. They're not thinking about what they're going to do in 11 years. They're thinking pretty close. And so I don't think when you threaten from 10 to 20, that that motivates them. That's what I've seen. Mr. Grothman. I think that's an insulting thing to say, but I've gone over my time. Chairman Gowdy. The gentleman yields back. The gentleman from Massachusetts is recognized. Mr. Lynch. Thank you, Mr. Chairman, and thank you and the ranking member for holding this important hearing. And I want to thank the members in the panel for helping the committee with its work. Director Baum, back in 1993 till about 2009, your position as director, even though you're acting director, Director of the Office of National Drug Control Policy was a Cabinet-level position. I have joined with Mr. Rothfus and a large group of Democrats and Republicans writing to President Trump asking him to reestablish the Director of the Office of National Drug Control Policy as a Cabinet-level position. Could you tell the committee what that might mean if we were to reelevate that position? Mr. Baum. Thank you, Congressman, for the question. You know, in my service at ONDCP, both under the Bill Clinton administration and the George W. Bush administration, I watched Barry McCaffrey and John Walters operate. And I see that being in the Cabinet, being at the Cabinet meetings, and being able to engage as an equal with the other Secretaries was something that's valuable. I have to say, in the Trump administration, I've had strong support from the Cabinet. I've met with the Cabinet Secretaries and engaged with them frequently. So that political support is very strong in the Trump administration. But I do understand your point that it can be an asset to be formally included in the President's Cabinet. Mr. Lynch. Right. I want to go back to the marijuana question. So in my State, by referendum, the citizens of Massachusetts just voted to approve of recreational marijuana in my State. Now, my personal experience has been--I opposed to that, but we lost decisively on the ballot question. I just cannot see how flooding the streets with another drug is going to help. And part of my work as a Member of Congress has been to establish a residential treatment facility for young people, because the age at which these young people have been lured into OxyContin and then heroin and fentanyl is just--it's a horrific situation. And I've got probably 500--500 kids that have died of a drug overdose. And, Mr. Flattery, I'm totally sorry for your loss, and I certainly empathize with your position, and I'm thankful for your courage to come forward, you and your wife, with your son's situation. But I could find no really decisive studies on the effects of marijuana on the developing brain. You know, and obviously, when you--when you put something out--when you legalize recreational marijuana, society is putting this imprimatur of acceptance and implied suitability so that people are going to look like, hey, this is something that's not harmful, and I can engage in that. Can you talk a little bit about what that might mean for the general population? Mr. Baum. Thank you, Congressman. Let me say a few words, and then maybe Dr. Humphreys has a few words as well. You know, States have a lot of options in how they manage something like marijuana. And I think sometimes that we're looking at this sort of all-in-or-all-out kind of policy. And if States want to alter and have a less severe sentencing---- Mr. Lynch. And I totally support that. Believe me, I don't think people should be thrown in jail for smoking marijuana. That doesn't happen. Mr. Baum. And that's my point. So States have options, but the idea that it's going to be so legal and so accessible to young people really does put themselves at risk. And, you know, there's a lot of research already on the harmful effects, physical and cognitive, caused by marijuana. And this research was done on earlier marijuana before we had these incredible high levels of THC, which we have now. The new forms of marijuana, shatter and wax and the liquids that are being vaped, these are very, very powerful substances. The super powered marijuana has not been tested. So I just--you know, as a parent, I just don't want my kids and other kids in this country at a young age being exposed to these substances. And I think we really got to think about, when we make these policy decisions, what's best for your youth. Mr. Lynch. Mr. Humphreys, you want to add? Dr. Humphreys? Mr. Humphreys. Yes, sir, I would. Marijuana is way more potent than it's been in previous eras, and people are using it every single day much more. So I'm quite worried about the public health impact. I think it's being underestimated how destructive this drug can be. And I'm also worried about the fact we're having a commercial industry promoting the product with very little regulation. It's kind of like tobacco industry's fantasy of what they always wanted, the marijuana industry is getting. I think the regulatory framework in these States needs to be much, much stronger, otherwise we're going to regret it deeply. Mr. Lynch. Thank you. I yield back, Mr. Chairman. Chairman Gowdy. The gentleman from Massachusetts yields back. The gentlelady from Florida is recognized. Mrs. Demings. Thank you so much, Mr. Chairman. Thank you for this very important hearing today. And thank you as well to our witnesses, particularly Mr. and Mrs. Flattery. We thank you for introducing us to Kevin today. As a former police chief, we in Florida are all too familiar with the devastation drug addiction inflicts on families and on every community it touches. First, we battle pill mills and--but now we see ourselves--last year, we lost 14 persons a day, higher than even during the height of the pill mill crisis. In Orange County, the sheriff's office responded to more than 160 overdoses in the first 3 months of this year. Is this an epidemic? I would say yes, it is. Too often, the criminal justice system, as we've heard many times today, serves as the initial stop for individuals suffering from addiction disease. The Orange County jail has become the de facto and is called the largest drug treatment center and mental health provider in the region. In the Obama administration, we saw a shift to a public health model of response to the opioid epidemic and an increase focused on prevention, treatment, and recovery efforts. Dr. Humphreys, can you just give us some examples of prevention treatment and recovery efforts that were expanded under the Obama administration and why these efforts are so important in fighting the drug addiction crisis? Mr. Humphreys. Thank you for that question. I'd be very happy to do so. We saw addiction as a health problem, and, therefore, we tried to build health services directly into the mainstream healthcare system. Historically, addiction treatment has been funded by, you know, a separate block grant away from all of medicine. That makes the services uncoordinated. It makes them hard to access. So that is why--wanting to break away from that is why the Affordable Care Act says that taking care of substance abuse disorders is an essential healthcare benefit. You go to the same healthcare system. It's reimbursed the same way. It makes it easier for people to access. They don't feel as stigmatized. They can talk to their regular doctor, and the doctor can get paid for intervening with it. Same thing in the Medicaid expansion. Covering substance abuse disorder as a core service, not an add-on, not a blocker, and not a special set aside, but a core service. Because, you know, this is a problem that is very prevalent among Medicaid enrollees. It's a health problem that needs to be addressed, and so we try to build everything in. And if we do that in Washington, our belief, and my belief, was that that makes it much more likely on the ground in your community and everyone else's community that the locals will work together too. They'll know who each other are and they'll work together to bring people back to health. Mrs. Demings. Thank you so much. And, Mr. Flattery, earlier, we were talking about some of the creativity from local jurisdictions, and you mentioned one of the barriers to that is just the need to reengineer, I believe you said, treatment programs. I think we ran out of time. I'd love to hear a little bit more of your thoughts on that. Mr. Flattery. Well, I believe that the treatment, the world of treatment, especially for opioid substance use disorder is entirely broken. In many rural areas of the country, there is no treatment at all. In those counties, particularly in my newly adopted State that have some treatment, there are limits. There are cost issues. There are insurance coverage issues. There's actual stigma from those in recovery who are judging others who are choosing medication-assisted treatment. There are prescribers who are charging cash on the barrelhead only and sometimes $500 to treat someone with buprenorphine. There are manufacturers of alternative medication-assisted treatment who are in every State capital lobbying and making statements about competitor medication-assisted treatment. All of those are creating barriers to people getting evidence-based treatment. And I previously had discussed some 30-day residential treatment programs who, I believe, are often treating people as customers and not patients, and they're detoxing and releasing people to the wild in a short-burst attempt. A 30-day attempt is woefully inadequate when we're dealing with a chronic long- term condition. So that's kind of what I--those are--there are a number of issues surrounding why our treatment system just does not work, and we need--we need to reengineer it with some of the enthusiasm that we're using today to discuss changing our Nation's healthcare system. Mrs. Demings. All right. Thank you so very much. Mr. Chairman, I yield back. Chairman Gowdy. The gentlelady yields back. The gentlelady from the Virgin Islands is recognized. Ms. Plaskett. Thank you, Mr. Chairman, and thank you for holding this hearing. The High Intensity Drug Trafficking Area program, or HIDTA, was created to provide assistance to Federal, State, local, and Tribal law enforcement agencies operating in areas determined to be critical drug trafficking regions in the United States. There are currently 28 HIDTA regions, which include almost 66 percent of the U.S. population in 49 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. To date, these regional HIDTAs have steadfastly worked with local law enforcement to coordinate efforts and share intelligence. Mr. Baum, do you consider the work of HIDTA integral to the advancement of the mission of the Office of National Drug Control Policy? Mr. Baum. Thank you, Congresswoman, for the question. We are extremely proud of the HIDTA program. They are working every day in a partnership, Federal, State, local, collaborating on looking at and studying the problem they face in each of these regions and deciding together on the priorities. I think it's important to make the point that ONDCP, we provide grants for the programs, but we don't tell them what to focus on. Ms. Plaskett. Right. Mr. Baum. It's a regionally focused program, and it's designed to bring people together and coordinate Federal, State, and local law enforcements, and they're producing very dramatic results. Actually, if you look at the amount of cash and assets they're seizing, they more than pay for themselves three times over, 3-1/2 times over. So I thank the Congress for their great support of the HIDTA program. It's really getting a great return on the dollar. They are really making a difference in our communities. Ms. Plaskett. As you talked about success, HIDTA initiatives identified over 8,800 drug trafficking organizations, disrupting or dismantling over 2,700 of them, and seizing over $895 million in cash and noncash assets from drug traffickers in 2015. And as you said, these were organizations working with local law enforcement who identify the threats specific to those areas, identify how to go after them, how to disrupt and to dismantle those activities in the areas in which they are working. I've seen the work that they're doing in the Virgin Islands. And as a former narcotics prosector, I'm just completely very--however I can be supportive of the work that they're doing in those areas is really important. But in the area in which I represent the U.S. Virgin Islands, and Puerto Rico, where HIDTA works together, they cover--that area is recognized by ONDCP in 2013 for its outstanding work in disrupting drug trafficking networks through the Caribbean destined for the mainland USA. Mr. Baum, would you agree that the HIDTA region that covers the U.S. Virgin Islands and Puerto Rico is integral to combating transit routes for drugs from South America into the U.S. mainland? Mr. Baum. Yes, absolutely, Congressman. It's a very important area, and it is sort of in the neighborhood of the world that faces a lot of drug challenges, and so we're very pleased to have the HIDTA there, and we know it's a significant threat that you face in the Virgin Islands. Ms. Plaskett. Yes. You know, we are--right now, the U.S. Virgin Islands, according to the FBI in 2016, has the highest murder rate per capita in the country, higher than any other State, commonwealth, or territory. And we know that most of it is due to drug trafficking. Most of the drugs are not used by Virgin Islanders. The Virgin Islands was purchased because of our geographic importance, and drug dealers are smart people. They recognize that there's an important route there as well and are using the islands for that. Nonetheless, the House today will likely appropriate over $1-1/2 billion to begin building a wall on our southern border, and meanwhile, the Virgin Islands and places like me are facing enormous murder rates, enormous disruption to our communities because of this drug trafficking, because of what's happening there. And I believe that a lot of that money, those billions of dollars that are being spent on that wall and appropriated there, could be better used to wall ourself from the drug trafficking that is coming through this country. Mr. Baum, is there any additional moneys that you think that HIDTA would need to be effective in its war against drugs? Mr. Baum. Congresswoman, the President in his fiscal year 2018 budget request asked for $246 million for the HIDTA program. That's the largest request ever from an administration. And so we're hoping to get Congress' support for that. And on the border security issue, border security is very important. We face a lot of challenges, and so there is a need for infrastructure and officials. And we're really pleased at the incredible leadership of Secretary Kelly in getting CBP and the DHS folks back engaged and combating drugs, so there's a lot that has to be done. Certainly, we think HIDTA is an important part of the drug enforcement solution. Ms. Plaskett. Thank you. I just wish Mexico would pay for it instead. I yield back. Chairman Gowdy. The gentlelady from the Virgin Islands yields back. I'll recognize myself for 5 minutes of questioning. Dr. Humphreys, it is currently against the law to prescribe controlled substances outside the course of a professional medical practice. It's a pretty arcane statute. It's not used all that often. But it strikes me that until you control that group that is uniquely empowered to prescribe controlled substances--and I appreciate the fact that Director Baum thinks it's an education issue. I don't know that many dumb doctors. I don't know that many--I don't think it's an education issue as much as it is a money issue. So how do we capture the attention of those uniquely situated people in our culture who have the authority to write controlled substance prescriptions? Mr. Humphreys. Thank you for that question, Mr. Chairman. I divide doctors up as follows: The biggest group of doctors are good people who do the right thing, and they need to be left alone. The second biggest group are good doctors who do the wrong thing, and they need education and training. There is a third group. It is a small group. It's probably less than 1 percent of physicians who are not good people, and they do the wrong thing knowingly. And we saw this, my time at ONDCP in Florida, a massive concentration of people giving out huge quantities of OxyContin. And I think at that point, they're no different than any other drug trafficker. The fact that they're an M.D. is irrelevant. They know what they're doing. They're being harmful, and that's why we have law enforcement to go after them, and I'm all for them doing that. Chairman Gowdy. Well, I know we do, and we certainly used to. It was phentermine and fenfluramine back when I was at the DA's office, but DA diversion is not as active. Unless you know something I don't know, they're not as active as they once were. So I get that it's hard to go after doctors. And just so the record's clear, my dad's a physician. I actually like doctors, but they are uniquely empowered in our culture. Gerry Connolly can't write a prescription for an antibiotic or a controlled substance. Doctors can. And you can be in this specialty but write an analgesic prescription. So I'm with you. I appreciate the deference you show to physicians that it's an education, and I do think the overwhelming majority want to do the right thing for the right reasons. But there's a lot of money in this particular realm. And until there are prosecutions for physicians who prescribe outside the course of a professional medical--and what I mean by that, just so nobody thinks I'm getting too complicated, writing a prescription on a cocktail napkin at a bar for someone you just met that you've never done any diagnostic test on, you just happen to take his or her word, I like my chances in front of a jury of that being outside the course of a professional medical practice. So, Mr. Baum, as you write your plan, it'd be great if you could address DEA diversion and whether or not they're being plussed up. I know it's tough to go after doctors. Juries are sympathetic with them, but they are uniquely positioned in our culture, and somehow or another we've got to address it. Dr. Humphreys, let me ask you this: You mentioned drug court a couple of times. Do you have a position or is there research that indicates whether preadjudication drug courts or postadjudication drug courts work better? Mr. Humphreys. I'm not aware of research that proves that point, because those populations are really different kinds of people, typically, the people who are given the option early versus later. I do know that both--both drug courts as well as other models that have been promulgated, HOPE Probation is one that now the Federal Government supports, 24/7 Sobriety on the alcohol side where you use the court as a mechanism to enforce abstinence with regular checks and treatment backup as needed all show, you know, very good outcomes. We should be doing those much more. By good outcomes I mean you get the trifecta, the public is safer as the person is held accountable, substance abuse goes down, and then incarceration goes down. Chairman Gowdy. Well, I want you to help me with something, if you can. And I ask this respectfully. As you travel, if you're ever invited to address a group of public defenders or criminal defense attorneys, oftentimes they will refuse the offer of drug court because probation is easier. It is not better for their client, but it's easier. So we've got to kind of reconfigure what is in the best interest of the client. Remaining addicted but just having a shorter period of probation is not in the best interest of the client, and they'll believe you and they won't believe an old prosecutor. So in my remaining time, Director Baum, in case my mom is watching, I want to be really clear, I'm not advocating for the legalization of marijuana. I want to be very, very clear about that. However, I don't understand why it's a Schedule I. It's certainly not treated as an inherently dangerous substance for which there is no medicinal value. It takes a tractor-trailer full of marijuana to even trigger a mandatory minimum under our drug laws. So is there any appetite for researching whether or not it should remain a Schedule I drug? Mr. Baum. Congressman, the administration doesn't have a position on that, but I'm happy to dialogue with your office. And let me just briefly say that we strongly support research on medical use of marijuana. And if there are obstacles that we see that prevent good research, we want to address those obstacles. Because if there are component elements of marijuana that could be put through the FDA process and turn into medicines that could help people in this country, we want to do that. So we do think there's a potential and we support research on the subject. Chairman Gowdy. Well, just so everyone's clear, methamphetamine is schedule what? Mr. Baum. I believe it's Schedule II. Chairman Gowdy. Cocaine is schedule what? Mr. Baum. Also II. Chairman Gowdy. Cocaine base is schedule what? Mr. Baum. A---- Chairman Gowdy. II. So it is scheduled lower than marijuana. And, again, you can schedule something and still not have it scheduled as a I? And I would encourage the powers that be, whoever you need to consult with in the administration, to at least explore whether or not it's scheduled correctly without being perceived as advocating for legalization. Mr. Baum. Understood. Chairman Gowdy. With that, Mr. Connolly, I want to give you a chance to--I'm reluctant to say whatever you want, but I'm going to give you a chance to conclude. Mr. Connolly. Well, I thank my friend. And I actually want to follow up, if I may, on what you just asked. So the point being made here in some ways, Mr. Baum, is if you--not you personally. If the government, Federal Government, on this subject, marijuana and how dangerous it is, has no credibility because of the lack of serious empirical work, it threatens our whole drug policy's credibility. And you have seen this happen in marijuana in the States. They're making decisions. Ms. Norton talked about eight States, but there are over 25 States that have in some fashion, including my home State of Virginia, liberalized their laws for medical reasons all the way to recreational reasons. I think you'd have to confess to the chairman's point, there was no empirical evidence to justify putting marijuana 50 years ago as a Schedule I drug. Who did that empirical evidence? Mr. Baum. Sir, could you repeat that? Who did what? Who made it schedule---- Mr. Connolly. There was no--I am asserting, and you can feel free to try to contradict, there was, in fact, no empirical evidence to justify putting marijuana ahead of the drugs the chairman just listed as a Schedule I drug 50 years ago. And I would--you brought up the need to have empirical research before we start rushing pill mill to approve it for medical purposes, and I agree with you. But here's the problem: As I said in my opening statement, only one Federal entity, NIDA, controls marijuana for legal purposes for experimentation, testing, and the like, research. And NIDA's mission is all about proving the harms of something. They've priority determined the outcome research. Nobody thinks NIDA is an objective neutral place to go to look at the good, the bad, and the indifferent about marijuana. It doesn't have that credibility. So if we're going to do what you suggest, we need to have a different entity with credibility where we're looking at objective evidence and science, and then we can determine, well, where does marijuana work? Mr. Humphreys made the point that there's a more lethal or stronger, more fortified versions of marijuana coming out that concern us. But we put a lot of people in jail, and we've treated this like it's more dangerous than cocaine and the other substances the chairman--and it's had huge consequences based on very little scientific evidence. I'm not arguing for the legalization either. I agree with my friend from South Carolina, I'm not going there, but neither can I justify the current policy of treating it as the world's most dangerous drug with this classification. You can feel free to respond, and I'm done. Mr. Baum. Congressman, I understand the point that you're making. I would love to go with you in your district to talk to police--police chiefs and sheriffs. I think in reality, on the street, police, sheriffs, they don't treat marijuana the way they treat heroin and fentanyl. So I think in practice, there is a prioritization of the most deadly drug threats. Chairman Gowdy. I think--I actually think that's his point, is that law enforcement doesn't, our sentencing scheme does not. Methamphetamine and marijuana are not treated the same from a sentencing standpoint, but yet marijuana is considered to be inherently dangerous with no medicinal value, therefore, a Schedule I. And it would just be helpful, again, to Mr. Connolly's point, for us to have some consistency, or at least be able to explain why certain drugs are Schedule I and others are not. And, you know, we can save that for another day. And, again, that's coming from two people that are not advocating for the legalization, just for some common sense in how it's scheduled. On behalf of all the members, I want to thank all of our witnesses for your expertise. Mr. and Mrs. Flattery, in your case, your very tragically earned expertise in this area. And I cannot imagine how painful it is. Any and every parent--and you don't have to be a parent to appreciate how difficult what you have done today is. And I salute you for your advocacy so other parents do not have to live through what you and your wife have lived through. I want to thank all the witnesses for your collegiality with one another and your comity with one another and with the committee. And with that, if there's no further business--thank you, Mr. Connolly--without objection, the committee stands adjourned. [Whereupon, at 12:31 p.m., the committee was adjourned.] APPENDIX ---------- Material Submitted for the Hearing Record [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] [all]