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

                     THE OPIOIDS EPIDEMIC: IMPLICATIONS FOR
                              AMERICA'S WORKPLACES

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

                                  JOINT HEARING

                                   BEFORE THE

                            SUBCOMMITTEE ON HEALTH,
                        EMPLOYMENT, LABOR, AND PENSIONS

                                    AND THE

                     SUBCOMMITTEE ON WORKFORCE PROTECTIONS

                                     OF THE

                             COMMITTEE ON EDUCATION
                               AND THE WORKFORCE
                         U.S. HOUSE OF REPRESENTATIVES

                         ONE HUNDRED FIFTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

               HEARING HELD IN WASHINGTON, DC, FEBRUARY 15, 2018

                                   __________

                               Serial No. 115-35

                                   __________

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                    COMMITTEE ON EDUCATION AND THE WORKFORCE

                   VIRGINIA FOXX, North Carolina, Chairwoman

    Joe Wilson, South Carolina           Robert C. ``Bobby'' Scott,
    Duncan Hunter, California                Virginia
    David P. Roe, Tennessee              Ranking Member
    Glenn ``GT'' Thompson, Pennsylvania  Susan A. Davis, California
    Tim Walberg, Michigan                Raul M. Grijalva, Arizona
    Brett Guthrie, Kentucky              Joe Courtney, Connecticut
    Todd Rokita, Indiana                 Marcia L. Fudge, Ohio
    Lou Barletta, Pennsylvania           Jared Polis, Colorado
    Luke Messer, Indiana                 Gregorio Kilili Camacho Sablan,
    Bradley Byrne, Alabama                 Northern Mariana Islands
    David Brat, Virginia                 Frederica S. Wilson, Florida
    Glenn Grothman, Wisconsin            Suzanne Bonamici, Oregon
    Elise Stefanik, New York             Mark Takano, California
    Rick W. Allen, Georgia               Alma S. Adams, North Carolina
    Jason Lewis, Minnesota               Mark DeSaulnier, California
    Francis Rooney, Florida              Donald Norcross, New Jersey
    Paul Mitchell, Michigan              Lisa Blunt Rochester, Delaware
    Tom Garrett, Jr., Virginia           Raja Krishnamoorthi, Illinois
    Lloyd K. Smucker, Pennsylvania       Carol Shea-Porter, New Hampshire
    A. Drew Ferguson, IV, Georgia        Adriano Espaillat, New York
    Ron Estes, Kansas
    Karen Handel, Georgia

                          Brandon Renz, Staff Director
                     Denise Forte, Minority Staff Director
                                     ------

            SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS

                        TIM WALBERG, Michigan, Chairman

    Joe Wilson, South Carolina           Gregorio Kilili Camacho Sablan,
    David P. Roe, Tennessee                Northern Mariana Islands
    Todd Rokita, Indiana                   Ranking Member
    Lou Barletta, Pennsylvania           Frederica S. Wilson, Florida
    Rick W. Allen, Georgia               Donald Norcross, New Jersey
    Jason Lewis, Minnesota               Lisa Blunt Rochester, Delaware
    Francis Rooney, Florida              Carol Shea-Porter, New Hampshire
    Paul Mitchell, Michigan              Adriano Espaillat, New York
    Lloyd K. Smucker, Pennsylvania       Joe Courtney, Connecticut
    A. Drew Ferguson, IV, Georgia        Marcia L. Fudge, Ohio
    Ron Estes, Kansas                    Suzanne Bonamici, Oregon
                     SUBCOMMITTEE ON WORKFORCE PROTECTIONS

                        BRADLEY BYRNE, Alabama, Chairman

    Joe Wilson, South Carolina           Mark Takano, California,
    Duncan Hunter, California              Ranking Member
    David Brat, Virginia                 Raul M. Grijalva, Arizona
    Glenn Grothman, Wisconsin            Alma S. Adams, North Carolina
    Elise Stefanik, New York             Mark DeSaulnier, California
    Francis Rooney, Florida              Donald Norcross, New Jersey
    A. Drew Ferguson, IV, Georgia        Raja Krishnamoorthi, Illinois
    Karen Handel, Georgia                Carol Shea-Porter, New Hampshire

                               C O N T E N T S

                                  ----------
                                                                       Page

    Hearing held on February 15, 2018................................     1

    Statement of Members:
        Byrne, Hon. Bradley, Chairman, Subcommittee on Workforce
          Protections................................................    52
            Prepared statement of....................................    54
        Sablan, Hon. Gregorio Kilili Camacho, Ranking Member, a
          Representative in Congress from the Northern Mariana
          Islands....................................................     4
            Prepared statement of....................................     6
        Takano, Hon. Mark, Ranking Member, Subcommittee on Workforce
          Protections................................................    70
            Prepared statement of....................................    72
        Walberg, Hon. Tim, Chairman, Subcommittee on Health,
          Employment, Labor, and Pensions............................     2
            Prepared statement of....................................     4

    Statement of Witnesses:
        Allen, Ms. Lisa, President and CEO, Ziegenfelder Company.....    16
            Prepared statement of....................................    18
        Andrews, Dr. Christina M., PhD, Assistant Professor,
          University of South Carolina...............................    33
            Prepared statement of....................................    35
        Rhyan, Mr. Corwin, MPP, Senior Health Care Analyst, Altarum
          Institute..................................................     7
            Prepared statement of....................................     9
        Russo, Ms. Kathryn J., Principal, Jackson Lewis P.C..........    41
            Prepared statement of....................................    43

          THE OPIOIDS EPIDEMIC: IMPLICATIONS FOR AMERICA'S WORKPLACES

                                  ----------

                          Thursday, February 15, 2018

                            House of Representatives

                   Committee on Education and the Workforce,

            Subcommittee on Health, Employment, Labor, and Pensions

                                 joint with the

                     Subcommittee on Workforce Protections

                                Washington, D.C.

                                  ----------

        The subcommittees met, pursuant to call, at 10:02 a.m., in
    Room 2175, Rayburn House Office Building. Hon. Tim Walberg
    [chairman of the Subcommittee on Health, Employment, Labor, and
    Pensions] presiding.
        Present: Representatives Walberg, Byrne, Wilson of South
    Carolina, Rokita, Brat, Grothman, Stefanik, Allen, Lewis,
    Mitchell, Smucker, Ferguson, Estes, Handel, Sablan, Takano,
    Fudge, Bonamici, Adams, Blunt Rochester, Krishnamoorthi, and
    Shea-Porter.
        Also Present: Representatives Foxx, Thompson, Guthrie, and
    Scott.
        Staff Present: Marty Boughton, Deputy Press Secretary;
    Courtney Butcher, Director of Member Services and Coalitions;
    Michael Comer, Deputy Press Secretary; Rob Green, Director of
    Workforce Policy; Callie Harman, Professional Staff Member; Amy
    Raaf Jones, Director of Education and Human Resources Policy;
    Nancy Locke, Chief Clerk; John Martin, Workforce Policy
    Counsel; Kelley McNabb, Communications Director; Rachel Mondl,
    Professional Staff Member/Counsel; James Mullen, Director of
    Information Technology; Alexis Murray, Professional Staff
    Member; Krisann Pearce, General Counsel; Benjamin Ridder,
    Legislative Assistant; Molly McLaughlin Salmi, Deputy Director
    of Workforce Policy; Olivia Voslow, Legislative Assistant;
    Joseph Wheeler, Professional Staff Member; Lauren Williams,
    Professional Staff Member; Michael Woeste, Deputy Press
    Secretary; Tylease Alli, Minority Clerk/Intern and Fellow
    Coordinator; Christine Godinez, Minority Labor Policy
    Associate; Carolyn Hughes, Minority Director Health Policy/
    Senior Labor Policy Advisor; Eunice Ikene, Minority Labor
    Policy Advisor; Stephanie Lalle, Minority Digital Press
    Secretary; Andre Lindsay, Office Assistant; Richard Miller,
    Minority Labor Policy Director; Jacque Mosely, Minority
    Director of Education Policy; Udochi Onwubiko, Minority Labor
    Policy Counsel; and Veronique Pluviose, Minority Staff
    Director.
        Chairman Walberg. We welcome each of you to today's joint
    committee hearing of the Subcommittee on Health, Employment,
    Labor, and Pensions and the Subcommittee on Workforce
    Protections; a joint hearing today. I would like to thank our
    witnesses for joining us for this important discussion on how
    the opioid epidemic is impacting work places, workers, and
    family members from across the country.
        Before I go on any further, I think it is important for a
    Committee that has responsibility for education and the
    workforce to not miss some of the current events that take
    place. To come this morning and to see this headline and these
    pictures of grieving parents, students, in this unbelievably
    evil killing of 17 in Florida. It is not something that we can
    pass or should pass up easily.
        We are having this hearing because there is deep suffering
    in our communities relative to opioid heroin abuse, but there
    are other points of suffering as well. And we are earnestly
    looking for ways to deal with that suffering and pain that is
    so personal. But yesterday's tragic events in Parkland, Florida
    force us, I believe, to acknowledge once again that suffering
    and pain sometimes grip a community in the most shocking and
    unexpected ways. I have heard it said this morning and last
    night that thoughts and prayers are not enough. And they are
    not enough. I can understand why people would say that. But as
    someone who believes in prayer, who has seen its power over and
    over in my life, I know that any petition to the God who
    created us, the God whose heart is also broken, literally
    broken I am certain, when lives are ended in such a tragic and
    evil way, that these prayers are heard by Him.
        And so I believe this morning we need to pray for those who
    are burdened by grief and loss and pain this morning. We need
    to pray for those who are fighting to stay alive, we need to
    pray for those who are now going to have to find a way to move
    forward. And we need to pray for each other. We need to pray
    for understanding, for wisdom, for grace. We need to pray for
    guidance on what we can do because we have to do something, but
    not just something, to do the right thing for our communities,
    for our families, for our lives, for our future, to stop the
    heartache before it happens, and, when we can, to help rebuild
    when the need arises.
        So not desiring to offend in any way, and yet believing
    that we have a purpose that causes us to need higher counsel, I
    would ask you to allow me to pray.
        I come to you, Father God, thanking You for wisdom that You
    can give, and I thank You that You care for us and You hurt
    when we hurt. And today I ask that You give wisdom to all in
    Florida, as well as here in this room as we deliberate on
    things to help and not hurt_that You give us wisdom beyond
    ourselves. To be with the families in Florida who are hurting
    right now, who have lost tragically young lives. We pray for
    the school, that wisdom will be given to its administration as
    they move forward, and ultimately we will find answers that
    will move us forward in this great country, to be a united
    nation working together. And I pray this in Your powerful name.
    Amen.
        The tragic opioid epidemic has unfortunately become a major
    part of our national conversation and a problem that we must
    understand and address. Too many Americans from all walks of
    life_and I am sure everyone at these tables have experienced it
    in their district_with real live families and people that have
    suffered under the crushing impact of this terrifying epidemic
    and the abuse that goes with it. Far too many are dying from
    opioid misuse and overdose every day. According to the Centers
    for Disease Control and Prevention, opioid use, including
    prescription opioids, heroin, and fentanyl, was the cause of
    over 42,000 deaths in 2016, 40 percent of which involved a
    prescription. As policymakers, we need these statistics to
    inform what we do, but it is most important to remember that
    every casualty was a person with incredible potential. Not only
    were they members of our larger social communities, they were
    members of our work communities. Our coworkers see more of us
    during the average day than even our own families. The people
    we see in the workplace have a significant role in each of our
    lives and are part of the community around us. Many Americans
    work alongside those who suffer from opioid misuse, but may not
    understand what can be done to help their fellow coworker.
        According to the National Council on Alcohol and Drug
    Dependence, 70 percent of the 14.8 million individuals that are
    misusing drugs, including opioids, are currently employed.
    While this statistic is alarming, it also shows the workplace
    can be a resource for the community to identify those who are
    struggling with opioid misuse. And we are already seeing some
    employers assisting employees in their treatment and
    rehabilitation, and how encouraging that is. Already, many
    employers have deemed it necessary to update or promote
    existing policies to provide support to employees who struggle
    with opioid abuse. In fact, 70 percent of U.S. companies and 90
    percent of Fortune 500 companies have an employee assistance
    program to assist employees struggling with substance abuse and
    other problems. It is reassuring to see these kinds of programs
    and practices implemented by companies who want to see their
    employees healthy and productive. But more needs to be done.
    While much of the current dialogue is about the dangers of the
    opioid epidemic, we also need to hear about the proactive steps
    employers are taking to fight this epidemic within their
    workplaces and broader communities.
        That brings us to today's discussion of how the opioid
    epidemic is impacting American workers and what some employers
    are doing to address this problem. We must understand that the
    federal government must not act as a barrier or tie the hands
    of employers when it comes to addressing opioid abuse and the
    workplace. Rather, we should fortify employers' efforts to help
    their employees and family members who are affected by this
    epidemic.
        I look forward to hearing from our witnesses today and I
    thank Chairman Byrne for co-chairing this important joint
    committee hearing. And now recognize Ranking Member, and my
    good friend, Sablan, for his opening remarks.
        [The statement of Chairman Walberg follows:]

       Prepared Statement of Hon. Tim Walberg, Chairman, Subcommittee on
                    Health, Employment, Labor, and Pensions

        Good morning, and welcome to today's joint subcommittee hearing
    with the Subcommittee on Workforce Protections. I'd like to thank our
    witnesses for joining us for this important
        discussion on how the opioid epidemic is impacting workplaces,
    workers, and families cross this country.
        The tragic opioid epidemic has unfortunately become a major part of
    our national conversation, and a problem that we must understand and
    address.
        Too many Americans - from all walks of life and from all parts of
    the country - are facing the terrifying realities of opioid abuse, and
    far too many are dying from opioid misuse and overdose every day.
        According to the Centers for Disease Control and Prevention, opioid
    use (including prescription opioids, heroin, and fentanyl) was the
    cause of over 42,000 deaths in 2016, 40 percent of which involved a
    prescription.
        As policymakers, we need these statistics to inform what we do. But
    it's most important to remember that every casualty was a person with
    incredible potential.
        Not only were they members of our larger social communities, they
    were members of our work communities.
        Our coworkers see more of us during the average day than even our
    own families. The people we see in the workplace have a significant
    role in each of our lives, and are part of the community around us.
        Many Americans work alongside those who suffer from opioid misuse,
    but may not understand what can be done to help their fellow coworker.
        According to the National Council on Alcohol and Drug Dependence,
    70 percent of the 14.8 million individuals that are misusing drugs,
    including opioids, are currently employed.
        While this statistic is alarming, it also shows the workplace can
    be a resource for the community to identify those who are struggling
    with opioid misuse. And, we are already seeing some employers assisting
    employees in their treatment and rehabilitation.
        Already, many employers have deemed it necessary to update or
    promote existing policies to provide support to employees who struggle
    with opioid abuse.
        In fact, 70 percent of U.S. companies and 90 percent of Fortune 500
    companies have an employee assistance program to assist employees
    struggling with substance abuse and other problems.
        It is reassuring to see these kinds of programs and practices
    implemented by companies who want to see their employees healthy and
    productive. But more needs to be done.
        While much of the current dialog is about the dangers of the opioid
    epidemic, we also need to hear about the proactive steps employers are
    taking to fight this epidemic within their workplaces and the broader
    community.
        That brings us to today's discussion of how the opioid epidemic is
    impacting American workers and what some employers are doing to address
    this problem.
        We must understand that the federal government must not act as a
    barrier or tie the hands of employers when it comes to addressing
    opioid abuse and the workplace. Rather, we should fortify employers'
    efforts to help their employees and family members, who are affected by
    this epidemic.
        I look forward to hearing from our witnesses today, and thank
    Chairman Byrne for co-chairing this important joint subcommittee
    hearing.
                                     ______

        Mr. Sablan. Thank you very much, Mr. Chairman. Good
    morning, everyone. I would also like to associate myself with
    the prayer of the Chairman. Our hearts and prayers also go out
    to the victims, seven fatalities. It is tragic. And I couldn't
    help asking, so what is next, what is next? With all due
    respect, respectfully not being partisan, I would maybe
    consider that Congress would reconsider the plans and rather
    than cutting funding for mental health we should actually
    increase it so that those who need the help throughout our
    community, our country, would have access to mental health
    services and programs.
        The opioid crisis has ravaged communities across the United
    States. It is no surprise that the impacts of the crisis are
    being felt in the workplace by both workers and businesses.
    From workplace accidents and injuries, employees' absenteeism,
    low morale, and increasing lost productivity, our workplaces
    are experiencing the challenges of this epidemic. U.S.
    companies lose billions of dollars a year because of employees'
    drug and alcohol use and related problems. But it is the human
    toll that is the most devastating consequence of this epidemic.
        We know that those with substance use disorders come from
    all walks of life. From our factories to our boardrooms, the
    health needs of our workforce should be a top priority. Sadly
    these needs have gone unmet and behavioral healthcare has been
    out of reach for many, particularly lower wage workers, racial
    and ethnic minorities, and other marginalized populations. The
    Affordable Care Act improved and expanded treatment for people
    with substance use disorders through Medicaid and private
    insurance, although not for the people of my district, the
    Northern Marianas, and the other areas. The law mandated
    substance use disorder treatment as part of essential health
    benefits and brought in parity requirements to ensure that
    behavioral health is covered at the same levels as other
    medical coverage. Further, insurance can no longer deny
    coverage to people with substance use disorders or mental
    health conditions. Maintaining these important gains is
    paramount in the response to this crisis. Attempts to roll back
    these advances by weakening consumer protections or cutting
    Medicaid will only take us backwards. Additional funding at the
    federal level to combat the crisis will be squandered if we do
    not provide access to health coverage and a safe place to live
    and work.
        The President's new budget proposal is another missed
    opportunity to have a meaningful conversation about improving
    health in this country. Proposing to eliminate coverage and
    protection for millions of Americans is counterproductive,
    particularly during a crisis of this magnitude. Addressing the
    opioid epidemic requires a robust and coordinated approach.
    Efforts to prevent workplace injuries and illnesses are a
    critical step toward avoiding the prescription of opioids that
    initiates abuse.
        We should examine all the impacts that substance use
    disorder has on families and all the tools we have to help,
    including expanding prevention efforts, focusing on the entire
    family, increasing access to treatment, and facilitating
    recovery. We need to support those in recovery and provide them
    with economic opportunity to reintegrate into the community.
    Addressing addiction through treatment instead of punishment
    and incarceration should be applied across the board to all
    communities.
        It is encouraging that the community is taking time to
    discuss this issue and I am hopeful we can address it through
    increased funding for effective evidence based programs that
    help increase access, health coverage, and treatment. To help
    the workforce is key to help the economy.
        I thank the witnesses for taking the time to testify today
    and I look forward to hearing from them. I thank the two
    chairmen of the two subcommittees, and also my colleague and
    Ranking Member Mark Takano of the Workforce Protections
    Subcommittee.
        Thank you very much, Mr. Chairman. I yield back.
        [The statement of Mr. Sablan follows:]

      Prepared Statement of Hon. Gregorio Kilili Camacho Sablan, Ranking
        Member, Subcommittee on Health, Employment, Labor, and Pensions

        The opioid crisis has ravaged communities across the United States.
        It is no surprise that the impacts of the crisis are being felt in
    the workplace - by both workers and businesses. From workplace
    accidents and injuries, employee absenteeism, low morale, and increased
    illness and lost productivity, our workplaces are experiencing the
    challenges of this epidemic. U.S. companies lose billions of dollars a
    year because of employees' drug and alcohol use and related problems.
    But it is the human toll that is the most devastating consequence of
    this epidemic.
        We know that those with substance use disorders come from all walks
    of life. From our factories to our board rooms, the health needs of our
    workforce should be a top priority. Sadly, these needs have gone unmet
    and behavioral health care has been out of reach for many, particularly
    lower wage workers, racial and ethnic minorities and other marginalized
    populations.
        The Affordable Care Act improved and expanded treatment for people
    with substance use disorders through Medicaid and private insurance.
    The law mandated substance use disorders treatment as part of
    ``essential health benefits'', and broadened parity requirements to
    ensure that behavioral health is covered at the same levels as other
    medical coverage. Further, insurers can no longer deny coverage to
    people with substance use disorders or mental health conditions.
        Maintaining these important gains is paramount in the response to
    this crisis. Attempts to roll back these advances by weakening consumer
    protections or cutting Medicaid, will only take us backwards.
    Additional funding at the federal level to combat the crisis will be
    squandered if we do not provide access to health coverage and a safe
    place to live and work. The President's new budget proposal is another
    missed opportunity to have a meaningful conversation about improving
    health in this country. Proposing to eliminate coverage and protections
    for millions of Americans is counterproductive, particularly during a
    crisis of this magnitude.
        Addressing the opioid epidemic requires a robust and coordinated
    approach. Efforts to prevent workplace injuries and illnesses are a
    critical step toward avoiding the prescription of opioids that
    initiates abuse. We should examine all the impacts that substance use
    disorder has on families and all the tools we have to help, including
    expanding prevention efforts, focusing on the entire family, increasing
    access to treatment, and facilitating recovery. We need to support
    those in recovery and provide them with economic opportunity to
    reintegrate into the community. Addressing addiction through treatment,
    instead of punishment and incarceration, should be applied across the
    board to all communities.
        It's encouraging that the Committee is taking time to discuss this
    issue and I am hopeful that we can address it through increased funding
    for effective, evidence-based programs that help workers access health
    coverage and treatment. A healthy workforce is key to a healthy
    economy.
        I thank the witnesses for taking the time to testify today and look
    forward to hearing from them. Thank you. I yield back my time to the
    chair.
                                     ______

        Chairman Walberg. I thank the gentleman. Pursuant to
    Committee Rule 7(c) all subcommittee members will be permitted
    to submit written statements to be included in the permanent
    hearing record. And without objection, the hearing record will
    remain open for 14 days to allow statements, questions for the
    record, and other extraneous material referenced during the
    hearing to be submitted in the official hearing record.
        It is now my pleasure to introduce our distinguished panel
    of witnesses. Mr. Corwin Rhyan is a senior health care analyst
    at the Altarum Institute's Sustainable Health Strategies
    Program, where he studies health spending. Welcome. Ms. Lisa
    Allen is the president and CEO of Ziegenfelder Company, which
    offers help to employees needing addiction assistance. Welcome.
    Dr. Christina M. Andrews, PhD, is an assistant professor at the
    University of South Carolina where she examines addiction
    screening and treatment in diverse Medicaid health home models.
    Welcome. Ms. Kathryn J. Russo is a principal at Jackson Lewis,
    where she is the practice leader of the firm's Drug Testing and
    Substance Abuse Management Practice Group. Welcome.
        And now I will ask our witnesses to raise your right hand.
    We will swear you in to the record.
        [Witnesses sworn.]
        Chairman Walberg. Let the record reflect the witnesses
    answered in the affirmative.
        Before I recognize each of you to provide your testimony
    let me briefly explain our lighting system. It is like the
    traffic lights. When it is green, keep on going. When it turns
    yellow, you have a minute remaining to wrap your comments as
    quickly as possible. When it turns red, finish as quickly as
    you can. We will have the same process for our members of the
    Committee and they will indeed have opportunity to let you
    expand on some things maybe even you didn't get to in your
    testimony. We have the written testimony from each of you as
    well.
        And so without further ado, I will now recognize Mr. Rhyan
    for your five minutes of testimony.

      TESTIMONY OF CORWIN RHYAN, MPP, SENIOR HEALTH CARE ANALYST,
                           ALTARUM INSTITUTE

        Mr. Rhyan. Thank you, and good morning. Subcommittee
    Chairmen Walberg and Byrne, Subcommittee Ranking Members Sablan
    and Takano, and distinguished members of the Committee, thank
    you for the invitation today to testify on the current state of
    the opioid epidemic and the direct impacts we have observed on
    employers and the workplace.
        My name is Corwin Ryan; I am a senior health care policy
    analyst for Altarum, a nonprofit research and consulting
    institute headquartered in Ann Arbor, Michigan.
        In our work, we estimate the total nationwide economic
    burden of the opioid crisis exceeded $95 billion in 2016,
    including significant costs from losses in productivity and
    earnings, increased health care costs, and increased
    expenditures on criminal justice, child and family assistance,
    and education. Preliminary data for 2017 indicate this burden
    has continued to grow. The number of opioid-related overdose
    deaths in the 12 months prior to June 2017 were 20 percent
    higher than they were only a year before. If the epidemic
    continues to grow at its current rate, the total economic
    burden from 2017 through 2020 could exceed $500 billion for the
    entire United States.
        This epidemic impacts all parts of our society, but the
    combined impacts on households and the private sector account
    for the largest share of the societal burden and exceeded $46
    billion in 2016. This finding elevates the importance of
    employers, both as stakeholders directly impacted by the
    crisis, but also as potential leaders in preventing its spread
    and helping support treatment and recovery.
        Through recent work in Lorain County, Ohio, we heard from
    community stakeholders about the local economic impacts this
    epidemic can cause. Employers there are acutely aware of the
    impacts of opioids and they expressed repeatedly that they are
    having difficulty finding qualified candidates who can pass a
    drug test to fill local job openings. They have responded in
    some cases by changing their hiring and employment practices to
    increase the pool of potential employees. We have observed
    employers that are now more likely to consider candidates who
    have recovered or are recovering from a substance use disorder.
    They are also reconsidering zero-tolerance policies for
    existing employees and are working to help provide treatment
    and recovery services. In the most extreme cases, we have even
    heard employers express the desire to simply no longer drug
    test their employees. We would also expect that if employers
    continue to struggle to find qualified applicants that they
    will substitute for greater levels of automation and make
    larger capital investments.
        Many employers are also taking significant steps to improve
    the availability of treatment and recovery services. These
    businesses should be applauded for their efforts, supported in
    pursuing better care for their employees, and empowered to find
    the best solutions for their specific situations. Ensuring
    access to high quality evidence based treatment and recovery
    services through an employer can prevent overdoses and deaths.
    Employers should be given the flexibility to design and
    implement interventions that fit their employee population
    needs and work within available community resources, provided
    that evidence based practices inform their actions.
        Employers can also embrace their role as a key player in
    efforts to prevent future opioid abuses and addiction. They can
    offer prescription drug disposal sites and can work with
    insurers and third-party administrators to help cut unnecessary
    opioid prescriptions. When possible, employers should
    disseminate and share outcomes of their efforts to the broader
    employer community to help inform best practices.
        Finally, employers can also support caregivers, co-workers,
    friends, and family members of those suffering from addiction.
    All will need flexibility and resources so they can guide
    individuals through treatment and recovery.
        These Subcommittees should be applauded for their
    initiative to investigate the impacts of the opioid crisis on
    employers and the workforce. We have shown that employers are
    negatively impacted by the crisis, but can and will be at the
    forefront of implementing pivotal solutions to prevent and
    treat opioid addictions. Public policy should seek to give
    employers the resources they need to be an active and engaged
    ally in the fight against addiction, and allow them flexibility
    where needed to customize their responses. Including and
    empowering employers will go a long way toward accelerating the
    development and implementation of solutions to this nationwide
    epidemic.
        Thank you for the opportunity to present today. I look
    forward to any questions you may have.
        [The statement of Mr. Rhyan follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman Walberg. Thank you. I recognize Ms. Allen for your
    five minutes of testimony. Welcome.

     TESTIMONY OF LISA ALLEN, PRESIDENT & CEO, ZIEGENFELDER COMPANY

        Ms. Allen. Thank you. Chairmen Walberg and Byrne, Ranking
    Members Takano and Sablan, and distinguished members of the
    Subcommittee, thank you for inviting me to testify before you
    today.
        I am here today to talk about our efforts to employ in our
    commitment as a company to help individuals rebuild their
    lives. My name is Lisa Allen and I am the president and CEO of
    the Ziegenfelder Company, a privately held, family-owned
    business located in Wheeling, West Virginia. We make people
    smile with really cool treats and manufacture twin pops and
    other frozen items. I am honored to speak to you today on
    behalf of the U.S. Chamber of Commerce.
        A quick snapshot of our company. In 1860, Ziegenfelder
    started out as a neighborhood candy store located just across
    the street from where we are located today. My grandfather, Abe
    Lando, began working for the company after World War II and in
    1960 my family fully purchased the company. Although the
    company struggled financially for years, my father was able to
    turn the business around by developing Budget Saver twin pops.
    By reducing the expenses associated with the dairy industry and
    packaging the product in clear bags rather than traditional
    boxes, we were able to invest more in the company. Now, with
    three manufacturing facilities operating 24 hours a day, seven
    days a week, we make nearly 2.5 million twin pops every 24
    hours. Today, our products are in grocery stores nationwide in
    nearly every community across the country. Last year, we
    proudly placed over 40 million bags of pops in homes across
    America.
        While we are proud of this recent growth, the source of my
    pride comes from our team of employees we call a tribe. We call
    ourselves a tribe because we are individuals, families, and a
    community linked by our culture and our bright, vivid vision.
    And let me be clear, our growth has been possible because of
    our awesome tribe, which has grown from 65 to over 300 tribe
    members across the country.
        All members of our Ziggy tribe benefit from committed,
    compassionate hiring practices, which we expanded several years
    ago. These practices developed out of a realization following a
    chance conversation with a friend of mine from the U.S.
    District Attorney's Office. Apparently we had hired some of our
    tribe from a local halfway house, individuals who were in the
    midst of rebuilding their lives. After realizing this, we chose
    to become more intentional with respect to hiring specific
    populations, such as reentering citizens, veterans, and the
    homeless; all or none of whom could include recovering drug
    addicts, many of whom are in the throes of the opioid
    addiction.
        As I am sure other witnesses have said before, I have a lot
    to say on this topic at hand. There are many stories of how our
    tribe members have been directly and indirectly impacted by the
    opioid crisis, some of which I have detailed in my written
    testimony. Perhaps the best way to tell our story in the five
    minutes I have is to share with you one of the many stories.
    One of our most valued tribe member leaders is Sonny Baxter.
    The day after he came home in August of 2015, he joined our
    tribe. We didn't know then about his time before joining our
    trip, nor did we know how much more he would achieve
    afterwards. It turns out he came home after a 10 year prison
    sentence after his arrest at age 19 for possession with intent
    to distribute. While he was serving his sentence, he studied
    coding and training to become an addiction counselor in the
    hopes of helping others. In Sonny's words, ``I was part of the
    problem,'' and now he is part of the solution. During the two
    and a half years he has worked as a full-time member of our
    tribe, Sonny earned his associate's degree in software
    engineering from West Virginia Northern Community College just
    this past December. He recently applied to the Organizational
    Leadership Program at West Liberty University and is not only a
    full-time employee with us and the lead operator, he also works
    as a tech support at Wheeling Jesuit University. He has
    purchased a condo, he has a car, and he is using his training
    to help other members of our tribe who are recovering and
    reentering the workforce. With his help, our culture has become
    self-perpetuating. We believe that a job is absolutely the best
    antidote.
        Another of our tribe leaders, Tanner Defilbaugh, who also
    rebuilt his life following opioid addiction and incarceration,
    articulates it so well, ``It's easier to do the right thing
    when you are working and you have a steady job and you have a
    purpose.'' It is an honor to be part of such a tremendous group
    of people and humbling to think of some of the challenges that
    they and other members of our community and nation have endured
    and overcome.
        It sounds corny, but I think of the starfish parable. There
    are thousands of people that are in need of help in communities
    across this great nation. It's hard to help them all. But to
    each person that we're able to help, we make a difference. I
    truly believe, one by one, we are making a difference.
        Thank you for this opportunity to testify and I look
    forward to your questions.
        [The statement of Ms. Allen follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman Walberg. Thank you for your testimony. And I guess
    I should say I thank you for addicting my grandkids to twin
    pops. (Laughter)
        Ms. Allen. And I thank you for purchasing them, sir.
        Chairman Walberg. It is a better addiction than anything
    else.
        Ms. Allen. Absolutely. Have at it.
        Chairman Walberg. Okay.
        Ms. Allen. Thank you.
        Chairman Walberg. And I will recognize Dr. Andrews for your
    five minutes of testimony.

     TESTIMONY OF CHRISTINA M. ANDREWS, PHD, ASSISTANT PROFESSOR,
                      UNIVERSITY OF SOUTH CAROLINA

        Dr. Andrews. Subcommittee Chairmen Walberg and Byrne,
    Ranking Members Sablan and Takano, and distinguished members of
    the Committee, thank you for the opportunity to speak with you.
        I am a professor at the University of South Carolina and
    have spent the past decade researching how we can improve
    access to opioid use disorder treatment in the United States.
    Without question, the opioid epidemic is having a profound
    impact on our nation. We are now losing more people to opioid
    overdose than to AIDS in the height of that epidemic. And we
    will have lost 10 Americans to a fatal opioid overdose by the
    conclusion of this hearing today.
        The human cost of addiction and overdose is accompanied by
    a substantial financial price. In 2013 alone, expenses related
    to opioid use were estimated to be $79 billion. The epidemic
    presents new challenges for our economy. Reports from employers
    across the country tell a similar tale, opioid misuse is
    impairing their ability to hire and retain qualified workers.
    The Fed recently identified the epidemic as an emerging threat
    to economic growth. In its ``Beige Book: A Summary of Regional
    Economic Conditions,'' officials point to a concerning number
    of employers who are reporting difficulty finding qualified
    employees who are drug free.
        The research indicates a strong link between opioids and
    labor force participation. More prescriptions, more
    unemployment. The proportion of prime age men in the workforce
    has reached a historic low. Among those age 25-54 who are
    unemployed, a staggering 50 percent report taking pain
    medication on a regular basis, in most cases prescription
    drugs. About 70 percent of employers report negative
    consequences of opioid use, including absenteeism and drug use
    on the job.
        The most effective strategy to address these challenges is
    expansion of treatments. Decades of research have established
    that opioid addiction is a chronic disease and it can be
    treated effectively with a combination of medication and
    psychosocial intervention. Workers struggling with addiction
    must be connected to treatment so that they can achieve
    recovery and remain employed. Those who have dropped out of the
    workforce due to addiction must also receive treatment so that
    they can get back to work. This is the only realistic way to
    increase the supply of qualified workers. Drug testing is not
    an effective deterrent for people who have the disease of
    addiction. Treatment is the most evidence based approach to
    reduce opioid misuse in the workplace.
        How can we increase treatment? Let me share with you
    several recommendations, many of which come from the Opioid
    Commission appointed by President Trump. First, protect the
    Medicaid expansion and the health insurance exchanges. The
    Affordable Care Act has extended health insurance coverage to
    nearly 1 million people with opioid use disorders. Many are in
    the workforce. If the law were repealed, nearly one-third of
    all Americans with an opioid use disorder would suddenly lose
    access to lifesaving treatments. Medicaid waivers that impose
    work requirements could force beneficiaries to quit treatment
    in order to maintain coverage. Second, actively enforce parity
    regulations established under the Mental Health Parity and
    Addiction Equity Act of 2008. For employers to help their
    workers get the treatment they need we must ensure that their
    health plans provide equitable access to opioid use disorder
    treatment. Third, we need to uphold regulations on association
    health plans. The proposed rule issued by the Department of
    Labor last month would allow for the proliferation of poorly
    regulated health plans that are subject to few consumer
    protections. We must not allow Americans to spend their money
    on health plans that may not provide coverage for opioid use
    disorder treatment should they or a family member need it.
    Fourth, rapidly expand the distribution of naloxone, a
    lifesaving overdose reversal drug. We must get naloxone into
    every hospital, school, and local police station in the
    country. Thousands of lives can be saved by taking this step
    alone. Finally, increase prevention efforts. This includes
    better regulation of opioid prescribing, expanded options for
    safe disposal, support for effective non-opioid approaches to
    pain management, and expansion of injury prevention programs to
    reduce the need for pain medications.
        I applaud Congress for including an additional $6 billion
    over two years in the recent budget agreement for treatment of
    opioid use disorder. However, given the magnitude of the
    crisis, more funding is needed. It is crucial that these funds
    be directed specifically towards the purchase of naloxone, as
    well as evidence based treatment, such as buprenorphine and
    extended release naltrexone. Greater resources are going to be
    absolutely crucial to enable our states and our local
    communities to mount an effective response to this deadly
    epidemic.
        Thank you for your time. I look forward to your comments
    and questions.
        [The statement of Dr. Andrews follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman Walberg. We thank you. I recognize Ms. Russo for
    your five minutes of testimony.

      TESTIMONY OF KATHRYN J. RUSSO, PRINCIPAL, JACKSON LEWIS P.C.

        Ms. Russo. Chairmen Walberg and Byrne, Ranking Members
    Sablan and Takano, and distinguished members of the
    Subcommittees, thank you for inviting me to testify here today.
        My name is Kathryn Russo and I'm an attorney at Jackson
    Lewis where I manage the Drug Testing and Substance Abuse
    Management Practice Group. My practice consists of advising
    employers on drug and alcohol issues that arise in the
    workplace, including drug testing and disability management
    issues. Many employers I work with are struggling with the
    workplace impacts of opioid addiction, including issues such as
    increased work-related accidents and injuries, increased
    employee turnover, and increased workers compensation costs. An
    employer may learn that an employee is using opioids when an
    employee voluntarily discloses that he is using prescription
    painkillers or that he is addicted to opioids. Alternatively,
    the employee may test positive for opioids on a workplace drug
    test. The way that an employer responds to each of these
    situations depends on whether the employee can be characterized
    as disabled for purposes of federal and state discrimination
    laws. Current users of illegal drugs, including those who use
    prescription drugs without a valid prescription, are not
    protected as disabled under federal and state laws. This is why
    an employer can take disciplinary action against an employee
    who uses illegal drugs or tests positive for illegal drugs on a
    workplace drug test. But when an employee is using prescription
    medication to treat an illness or is recovering or recovered
    from a substance abuse problem, the employee is disabled under
    the Americans with Disabilities Act and comparable state laws.
    These laws require employers to offer disabled employees
    accommodations in certain circumstances. For example, when an
    employee voluntarily discloses that she has an opioid addiction
    and needs help, employers typically offer accommodations that
    might consist of a medical leave of absence to obtain
    evaluation and treatment or a change in the employee's work
    hours so that she can go to treatment sessions. Many employers
    have employee assistance programs that allow employees to seek
    confidential assistance with substance abuse problems.
        While employers are willing to help employees who disclose
    opioid addiction, they also must manage employee misconduct
    arising from illegal opioid use. Drug testing is an important
    tool used by employers to detect illegal drug use. I am seeing
    an increase in the number of employers who conduct drug
    testing, an increase in the number of drugs that employers test
    for, as well as an increase in the types of tests that are
    being conducted. Employers who conduct drug testing commonly
    use a ``five-panel'' drug test, indicating that five categories
    of drugs will be tested. In a typical five-panel drug test,
    however, the only opioids tested for are heroin, morphine, and
    codeine. Because of the prescription painkiller epidemic, many
    employers have concluded that a five-panel test is
    insufficient. And so employers increasingly are utilizing
    larger drug testing panels that include synthetic and semi-
    synthetic opioids.
        Employers increasingly are using post-accident testing and
    random testing to promote drug free workplaces. Random testing
    is a particularly useful tool for employers because it is
    unannounced and unexpected. Post-accident testing is also a
    very useful tool for employers to help rule out whether an
    employee had drugs in his system at the time of the accident.
    However, the U.S. Department of Labor's Occupational Safety and
    Health Administration's recent statements concerning post-
    accident drug testing have been a source of confusion and
    frustration for employers. In May 2016, OSHA stated in the
    preamble to its final rule on electronic record keeping that
    employers are prohibited from using drug testing as a form of
    adverse action against employees who report injuries or
    illnesses. In a subsequent memorandum, OSHA explained that
    post-accident drug testing may be permissible where there is a
    reasonable basis that drugs or alcohol could have contributed
    to the injury or illness. This standard is confusing to most
    employers. Many employers believe that OSHA now requires
    reasonable suspicion in order to test, while other employers
    have stated that they don't know what the rule means.
        Employers have complained that this post-accident standard
    first appeared in the preamble to an electronic record keeping
    rule and that there is no formal OSHA regulation addressing
    drug testing that employers were permitted to comment on before
    the rule took effect. Many employers believe that drug testing
    is an issue that is already regulated by many other federal,
    state, and local laws and that OSHA's position on this topic
    unnecessarily complicates the already complicated arena of
    workplace drug testing.
        I appreciate the opportunity to share my thoughts with the
    Committee.
        [The statement of Ms. Russo follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Chairman Walberg. Thank you. And thank you to each of the
    witnesses and trust that my colleagues and myself will note how
    well you all kept to the time limits, and may we do the same.
        I recognize myself now for my five minutes of questions.
        Mr. Rhyan, I noted earlier that today in our modern world
    we often spend more time with our co-workers than we do with
    anyone else, including our families. What role can you suggest
    that employers could play in supporting substance abuse
    recovery in the workplaces and in their communities?
        Mr. Rhyan. Absolutely. It's very important to consider the
    role of the employers. As you mentioned, there's a significant
    amount of time that individuals spend there and also the key
    role that employers play for the majority--in cases of
    providing insurance. And as a result, making sure that they are
    aware of the services that they can provide and they make them
    available to their employees. So, through that role, it is very
    important for employers to both make their employees aware of
    what services are available and also make sure that they get
    access to them when needed and in the best case possible.
        Chairman Walberg. On the other side of the ledger, what can
    employees do as part of this process as well in the workplace
    and in their communities?
        Mr. Rhyan. Yeah. I think employees can take an active role
    to work with their colleagues and certainly be aware of issues
    that become available. We know that having a good support
    system is really important for those trying to recover from an
    opioid addiction and so certainly employees being aware of, and
    being there for other individuals is very important.
        Chairman Walberg. Ms. Russo, you noted in your testimony
    there could be a situation in which an employee has a legal
    prescription for opioids and then tests positive during a drug
    test. In that case, would the employer be notified by the drug
    testing facility of the employee's opioid use?
        Ms. Russo. Typically no. So what happens is when the drug
    testing facility gets a positive test result, they send it to a
    medical review officer, who is a licensed physician, to analyze
    whether this is lawful or illegal drug use. If the medical
    review officer is satisfied that the person had a valid
    prescription, it will usually get reported to the employer as a
    negative. However, sometimes in very dangerous industries, I've
    seen arrangements where the medical review officer will flag it
    for the employer, just to note there may be a safety issue
    without disclosing what the issue is. And then the employer
    then has the obligation to talk to the employee to find out,
    you know, what's the situation, we think there may be a safety
    issue, and to work it out, just to make sure that the employee
    can use their medication and work safely in the workplace.
        Chairman Walberg. And there isn't a legal problem with
    doing that for the employer if they follow certain prescribed?
        Ms. Russo. No, that's correct; they can do that.
        Chairman Walberg. With prescription drugs?
        Ms. Russo. Yes.
        Chairman Walberg. Okay. Because, you know, as you
    mentioned, that five-points test, that does cause a bit of a
    problem when you are dealing with such an expansive problem
    that goes from opioids to heroin and back and forth at times.
        Ms. Russo. That's correct. Because, if an employee tests
    positive for opioids, the employer isn't going to know. Is it
    because of heroin or because they're using a prescription drug?
    So that's why there's this mechanism to have a medical review
    officer to review it to determine whether this is pursuant to a
    valid prescription or whether it's an illegal drug.
        Chairman Walberg. Okay. Mr. Rhyan, you stated that health
    care costs related to opioid crisis from 2001	2017 were almost
    $216 billion, stemming largely from emergency room visits to
    treat and stabilize patients after an overdose and associated
    costs. In your opinion, would earlier interventions to address
    opioid abuse help to decrease these associated health care
    costs and keep employees participating in the workforce?
        Mr. Rhyan. Yes, absolutely. There's two components to that.
    Certainly the first is preventing an opioid substance use
    disorder before it occurs. Because obviously any steps that can
    be taken to limit the excessive amounts of opioids that might
    be prescribed initially or any other steps that can be taken to
    decrease the likelihood that somebody develops a substance use
    disorder will prevent those adverse outcomes, such as emergency
    department visits, hospitalizations, or any downstream
    increased healthcare costs associated with diseases such as
    HIV, hepatitis B, hepatitis C, all of which we know are related
    to opioid substance use disorders and illegal drug use.
        The other component, that is of course providing treatment
    once we can identify those that have a substance use disorder.
    So, if we can provide better treatment and recovery services
    early on, we can prevent individuals from falling into those
    most severe outcomes. And that absolutely will cut healthcare
    costs on the front end if we can do that.
        Chairman Walberg. Thank you. My time has expired. I now re-
    present my friend and ranking member, Mr. Sablan.
        Mr. Sablan. Yeah, thank you. Thank you very much again, Mr.
    Chairman, for today's hearing.
        I have a question--actually two questions, Dr. Andrews, if
    I may. Thank you again for taking the time to testify today to
    all the witnesses.
        So, Dr. Andrews, can you discuss any gaps in access to
    substance use disorder treatment, especially in workplace
    health care coverage? For example, how does treatment access
    differ for blue collar workers as opposed to white collar
    workers? Does it differ across racial groups or socioeconomic
    groups?
        Dr. Andrews. Absolutely. Currently in the United States
    only about 10 percent of people with a substance use disorder
    ever receive any treatment for their condition. So that means
    we have about 90 percent of Americans who have an active
    substance use disorder and are not receiving treatment for
    their condition. The reasons for that are multifaceted and
    complex. Insurance access to treatment is an incredibly
    important aspect of it, as patients who report that they sought
    treatment but were unable to receive it indicate time and time
    again that financial barriers were key to their inability to
    access treatment. People in white-collar professions typically
    have greater likelihood of having a private insurance plan that
    offers higher reimbursement rates, that opens doors to entry
    into a greater number of addiction treatment programs. So, more
    choices means more likelihood of being able to enter treatment.
    People in blue-collar professions, maybe working in fields
    where whether it's in the restaurant service industry or
    different areas of manufacturing or construction, where
    insurance benefits may not exist or they may be less generous
    and--
        Mr. Sablan. I mean what about does it differ across racial
    groups or socioeconomic groups? You have alluded to the
    socioeconomic group, but the racial groups?
        Dr. Andrews. Right, right. While racial and ethnic minority
    groups do not use substances any more than whites--similar
    rates of use--they tend to access treatment less frequently.
    And there are a number of reasons for that, but again,
    insurance access, geographic access to treatment, barriers
    related to other challenges they may be facing related to
    employment, childcare, transportation, and the ability to
    access culturally and linguistically competent care are also
    key.
        Mr. Sablan. So you also testified, Dr. Andrews, that
    increased prevention efforts could stem the opioid crisis. The
    need for pain medication after a workplace-related injury or
    illness is often the gateway to addiction. Can you comment--we
    have a minute and a half--on what some of those workplace
    prevention programs might include and whether there are ways we
    can address the prescription of opioids in the workman's
    compensation system?
        Dr. Andrews. Right, absolutely. The research suggests that
    there is a really strong connection between working in
    industries that have high levels of injury. When people have an
    injury they're much more likely to receive opioid
    prescriptions, and when they receive opioid prescriptions they
    are at greater likelihood of developing an opioid use disorder
    as a result. So one of the upstream prevention strategies that
    we can use to try to break this sort of domino effect before it
    begins is illness and injury prevention programs, particularly
    those offered by OSHA, that can try to minimize the likelihood
    of those injuries from happening and the need for pain
    medication moving forward.
        Mr. Sablan. Ms. Russo, let me just ask you because you sort
    of mentioned and I am trying to understand. I have very little
    time, but when a person in the workplace is tested and it comes
    back positive, does the result show it, whether it is
    prescription drugs or heroin, for example? Or does it just show
    as positive?
        Ms. Russo. The result that the employer gets will usually
    just say positive and then it will show the category, cocaine,
    opioids, whatever it is. If the person is using a valid
    prescription it will already have been screened by the medical
    review officer who will then make it into a negative, so the
    employer won't know.
        Mr. Sablan. All right. Thank you, Ms. Russo. Thank you, Mr.
    Chairman.
        Chairman Walberg. I now recognize the chairman of the
    Workforce Protections Subcommittee and co-chairman of this
    hearing, Mr. Byrne from Alabama.
        Mr. Byrne. Thank you, Mr. Chairman. Thank you, ladies and
    gentlemen, for being here today. Very important topic.
        Ms. Russo, in my prior life I was an attorney who
    represented management, so this would come up not infrequently
    in conversations I would have with my clients. And I would
    inevitably have to talk with them about the Americans with
    Disabilities Act. So if you would please expand on--I know you
    have touched on this a little bit--expand on, first of all,
    what protections the employee has under the Americans with
    Disabilities Act in this particular environment, but also, most
    importantly, what the employer is permitted to do.
        Ms. Russo. Okay. So there's really two ways I think in the
    context of drug use that an employee would be protected under
    the Americans with Disabilities Act. So some employers will ask
    employees to disclose the use of prescription medication if
    they're in a very dangerous job. Generally, an employer would
    not ask that question, but to promote workplace safety they may
    ask people in very dangerous jobs to report it so that the
    employer can have a discussion with them about how can we
    accommodate it and make sure that you can do your job safely.
    That's one potential context that it may come up.
        The other one is that recovering and recovered substance
    abusers are protected as disabled. So if an employee comes
    forward and says, ``I have a problem. I need help,'' then they
    are now protected as disabled. The employer then would consider
    a reasonable accommodation, which in this instance typically
    means a leave of absence. So we would give them a leave of
    absence to go for evaluation and treatment. They might be
    eligible for a leave under the Family and Medical Leave Act.
    Even if they're not eligible, there may be other policies that
    the employer has that they can take advantage of. But in that
    instance, they would be--you know their substance dependence
    would be the illness that's protected. So the employer would
    not take adverse action against them.
        Mr. Byrne. Ms. Allen, I wanted to talk to you too about
    your testimony. I think you mentioned that when your employees
    are in trouble, many of them come to the company's leadership
    and ask for help. This is not the case in all workplaces. I am
    sure you know that. And not all employees feel comfortable
    talking about these issues with their bosses, the people that
    they work under. How did you first begin to reduce that stigma
    that surrounds opioid abuse within your workplace to create a
    community of acceptance and support?
        Ms. Allen. Well, thank you for the question. I would have
    to say that in our organization we all interact together. The
    folks that have worked with us, we have people who have been
    with us for 30 years and somebody new walked in the door today,
    I'm sure, in all three of our facilities. And we believe in
    close communication. We believe in observing each other, being
    friends, being family. When somebody--I think I said in my
    testimony--when somebody in our company hurts, we all hurt. So
    we grow. It's a small community. Wheeling, West Virginia is a
    small community. We grow up together. A lot of people have
    grown up together. We attend weddings. We attend funerals. So
    we know each other. And if we don't, then others do. And we
    communicate and we share. Just about every one of our shift
    changes in our facilities we try to have somebody on the floor
    saying, ``Hi, how are you doing? What's new?'' And, when
    somebody walks in the door, and goes straight to the telephone,
    and picks up the telephone, and makes a call, and puts it down,
    that used to tell us that person came from the halfway house,
    because they had to report in. And then, after their shift,
    they'd pick up the phone, make a call, and head out the door.
    And so it's just what we begin to observe. It's the culture
    that we create inside our company, and we talk about it. We
    communicate.
        Mr. Byrne. And talk also about the leadership, because
    everything starts at the top. So how does the leadership of an
    organization, whether it is a private sector company or
    anywhere else, how does the leadership communicate that to
    create that sort of culture?
        Ms. Allen. By leading. And I don't mean to be disrespectful
    with that comment, but leadership is about taking care of
    people in your fold. It's about inspiring people to grow and to
    develop and to do the right thing. It's about having
    influential behavior so that others can model that behavior and
    feel comfortable modeling that behavior. In our culture, we
    communicate together. We work together. And as I stand in front
    of our company, I encourage other leaders in our company to
    stand in front of all of our folks and recognize that we're
    just like the rest of the people inside our company, it makes
    it a safe environment. It makes it a non-threatening
    environment. It makes it an environment where people can feel a
    little vulnerable to say, ``Can I talk to you for a minute?''
        My door is always open. Our leadership, the rest of our
    leadership team, our doors are always open and we're there to
    help. What that also does for us, quite frankly, is it builds a
    strong community inside of our company and it makes us
    hopefully a model for other businesses to recognize the same.
        Mr. Byrne. Thank you. My time is up. I yield back.
        [The statement of Chairman Byrne follows:]

      Prepared Statement of Hon. Bradley Byrne, Chairman, Subcommittee on
                             Workforce Protections

        Good morning, and thank you Chairman Walberg for beginning today's
    joint subcommittee hearing.
        I'm pleased to be joining our witnesses and members of both
    subcommittees as we continue the discussion on the impact the opioid
    epidemic is having on American communities and workplaces.
        The alarming increase in the abuse and misuse of opioids is a
    matter of great national concern, and I am pleased that Congress and
    the private sector are having these discussions and actively looking
    for ways to reverse the damage of opioids in our communities.
        One of the most alarming aspects of this epidemic is that misuse
    and abuse of opioids can happen so quickly, and often begins with
    prescription medication.
        My home state of Alabama is not immune from this troubling
    development. Alabama ranks first in the nation in the number of
    painkiller prescriptions per capita, with more than 5.8 million opioid
    prescriptions written in 2015. That's more than 1.2 prescriptions per
    person.
        An unfortunate reality is that this epidemic is happening to our
    coworkers, and in business communities large and small. Employers and
    employees alike are seeing the personal and economic toll this epidemic
    is having.
        Only now are we grasping the tragic statistics that illustrate the
    impact this problem is having on the American workforce. According to
    one recent estimate, opioid abuse costs employers $18 billion per year
    in sick days and medical expenses.
        It is troubling to hear that workplaces around the country have
    been affected by opioid misuse and addiction. But increased costs are
    not the most troubling way this epidemic has impacted the workplace.
    According to the Bureau of Labor Statistics, the number of overdose
    fatalities on the job has increased by at least 25 percent annually
    since 2012.
        These facts are alarming because they show that employees who abuse
    drugs, like opioids, are creating unintended consequences for their
    fellow coworkers.
        Those who misuse any illicit substance while at work are creating a
    risky environment, and that can also lead to workplace incidents where
    other employees could be hurt on the job.
        Employers are recognizing the risks that opioid abuse has on the
    workplace, and it is reassuring to hear that businesses large and small
    are taking steps to address this problem in their organizations.
        It is encouraging to hear that more employers are looking for ways
    to identify, educate, and assist employees who struggle with opioid
    abuse and addiction. Employee Assistance Programs are a great tool to
    help employees get the resources they need to start on the road to
    recovery. I do believe more can and should be done to make employees
    more aware of these resources before it is too late.
        Employers and fellow coworkers play a pivotal role in keeping
    workplaces safe across the country. I join my colleagues in cautioning
    the federal government from taking broad and sweeping action to create
    unnecessary bureaucratic mandates that would inhibit employers who know
    what programs work best for their individual employees.
        Our witnesses today have proven that they are uniquely positioned
    to tell us more about how companies are adopting and executing new best
    practices to combat this tragic epidemic in our communities. I would
    like to thank the witnesses for sharing their stories about how the
    opioid epidemic affects the workplace, as well as what they are doing
    to help solve this problem.
        Working together with government, businesses, nonprofits, and local
    communities, I am hopeful we can bring an end to the opioid epidemic.
                                     ______

        Chairman Walberg. I thank the gentleman. I recognize now
    the ranking member on the Workforce Protections Subcommittee,
    Mr. Takano.
        Mr. Takano. Thank you, Mr. Chairman. I appreciate this
    opportunity to question our witnesses.
        My first questions are for Dr. Christina Andrews. Dr.
    Andrews, we know that access to health insurance coverage often
    makes the difference between whether someone seeks healthcare
    or foregoes it. Can you discuss the impact of the Affordable
    Care Act on the ability of patients to access substance use
    disorder treatment?
        Dr. Andrews. Certainly. The Medicaid expansion has been an
    absolutely critical tool used by states in order to improve
    access to opioid use disorder treatment. As I mentioned in my
    statement, roughly one-third of people who are living in the
    United States who have an opioid use disorder have access to
    insurance, either through Medicaid or through the newly
    established health insurance exchanges. And that enables them
    to access lifesaving treatment for their condition, most
    notably medications like buprenorphine and extended release
    naltrexone, which have been shown to dramatically reduce risk
    of overdose and death.
        In our research that we've done with stakeholders in 10
    states throughout the United States these leaders have
    indicated time and time again that a big part of their decision
    to expand Medicaid was related to the opioid epidemic and that
    they wanted to use every policy tool they had available to them
    in order to address this disorder because they were seeing the
    devastation that it was causing in their communities.
        Mr. Takano. So Medicaid has been an extremely, extremely
    important tool in addressing opioid addictions?
        Dr. Andrews. Absolutely.
        Mr. Takano. Well, the budget proposal released earlier this
    week calls for huge cuts to Medicaid funding, what will these
    cuts do to coverage?
        Dr. Andrews. Cuts to Medicaid in the midst of an escalating
    opioid epidemic could result in lost lives. I think that
    Medicaid being such an important tool for responding to this
    epidemic and getting treatment for people who need it make it
    really key. And the research that we've been doing, as well as
    a lot of evidence that's been coming out over the past few
    years, suggests that Medicaid has played an extraordinarily
    important role in increasing access to opioid use disorders.
        Mr. Takano. I just want it to be clear to people out there
    that when the administration talks about cutting back or
    repealing and replacing the ACA, that Medicaid expansion was a
    huge part of the Affordable Care Act. So, you know, I could be
    using the word Affordable Care Act, but one big chunk of the
    Affordable Care Act was the expanded Medicaid, which allows for
    just a tremendous number of people, millions of people, gaining
    access to it, gaining access to this insurance, therefore also
    being able to address their opioid addictions.
        There seems to be the notion that those on Medicaid are not
    working. However, a majority of Medicaid recipients are
    working. And that is what the head of the Inland Empire--IEHP,
    which is the Medicaid plan in my area, my county, in Riverside
    County--he tells me that, you know, up to 60 percent of the
    people are working. Those that are not are either disabled or
    they are caregiving for somebody. But many of these folks are
    on low-wage jobs where coverage is not available otherwise and
    so Medicaid fills in that gap.
        How does Medicaid impact the health of a workplace?
        Dr. Andrews. Mm-hmm, absolutely. Yes, I read that report.
    Excellent work by the Kaiser Family Foundation looking at non-
    elderly adults' participation in the workforce, and seeing
    upwards of 60 percent are already in the workforce. Those who
    are not able to be in the workforce, many of whom have
    substantial barriers to work. And one of the major ones is
    behavioral health disorders, including opioid use disorder
    treatment. So if we were to impose work requirements on this
    group of individuals it may force them to either quit treatment
    that they need to get well or it would force them to forgo
    treatment in order to maintain their health benefits.
        Mr. Takano. Very quickly, my time is running out. So really
    giving them access to the medical care, the Medicaid, actually
    will enable them to work.
        Dr. Andrews. Absolutely.
        Mr. Takano. And supporting the work requirement
    paradoxically would hamper their ability to get into the
    workforce?
        Dr. Andrews. Yes.
        Mr. Takano. Anyway, my time is up, Mr. Chairman, and thank
    you for the opportunity.
        Chairman Walberg. I thank the gentleman. Now I recognize
    our resident professor, Mr. Brat, from Virginia.
        Mr. Brat. Thank you, Chairman. Your words are prescient. I
    am going to--everyone is going off on the technical side and
    the policy side and the employer/employee side, so I am going
    to switch my comments a little. I really liked your comment on
    leadership. I think that is absolutely key. Back home I have a
    few leaders. Shinholser runs a foundation. My sheriff, Karl
    Leonard, in Chesterfield has a program that is so successful,
    when the inmates get out they come back in. They voluntarily
    come back in for treatment and recovery because the team and
    the spiritual bonds they formed are so powerful in helping them
    recover. And they realize this and they speak in those terms.
    And so that language, the inmates themselves use, ``I have a
    hole in my soul.'' That is their words. That is their language,
    right.
        And so today in the scientific world, and I taught
    economics and got a PhD, and et cetera. It is hard to quantify
    the soul, right. Not good stuff on that. So I will not bore you
    with going back to Plato and Aristotle. But a lot of ethics,
    for example, there is not data points on ethics. So terms like
    ``the good,'' you can't measure it. It is important, I think.
    Science, right. You can't prove science exists because it is an
    idea. And yet, I think all of you on this panel agree that
    science exists. And so this has a long pedigree in the history
    of philosophy. And so have we overdone it on the drugs and the
    treatments and the professionalism and missed the boat a little
    bit in terms of ``Hey, I got a hole in my soul. These people
    are helping me deal with that,'' is there anything going on in
    the literature? And if you all just want to take a quick crack
    at it, you get 45 seconds each according to the clock.
        Let us start with Mr. Rhyan.
        Mr. Rhyan. I think we very much need to look at solving
    this problem with a holistic approach. And so it's really both/
    and because you need both evidence-based treatment services,
    which have been established to work very well, and you also
    need to look at the individual. And certainly taking the
    approach of doing the care one individual at a time is really
    the best way to solve this problem. But that can be informed by
    the research as well. It's really both.
        Mr. Brat. Ms. Allen?
        Ms. Allen. Well, thank you, Congressman, for your question.
    I don't know the research. I don't do the research; we make
    popsicles. But we believe in people and we believe in the
    resiliency of the human spirit. And we have peer groups,
    informal peer groups inside our company that are friends with
    each other and they recognize problems and they work together.
    And I don't know, thankfully, because--I'm thankful because
    that's the way an organization should operate. I don't know all
    of the things that happen, but I know that they happen because
    people care about each other. And when you create that kind of
    an environment, I personally believe a lot of the statistics
    would take care of themselves.
        Mr. Brat. Thank you. Professor?
        Dr. Andrews. Well, the importance of human connection
    cannot be argued. And I really appreciate that comment. I think
    it's central to what we're doing. It must be a multifaceted
    approach. We need resources to buy naloxone because naloxone
    can save somebody who has experienced an overdose from dying.
    We need resources for medications like buprenorphine and
    extended release naltrexone. A recent evaluation coming out of
    Vermont, where they've been doing some excellent work around
    addressing the opioid epidemic, showed that providing that drug
    along with the kind of psychosocial support reduced use of
    opioids from 86 out of 90 days when people were coming down to
    only three days on average; the vast majority of people making
    huge improvements. And as the evidence suggests, we have the
    tools to solve these problems. We need to put the resources to
    getting them out to everyone who needs them.
        Mr. Brat. Super. Ms. Russo?
        Ms. Russo. I'm seeing more employers offering that kind of
    support to their employees, putting employee assistance plans
    in place, making sure they know about it, making sure that they
    know where in their geographical area they can go for help, you
    know, having strong policies, letting people know that you can
    take a medical leave of absence if you need it. And the other
    thing that many employers do, is they don't always terminate
    somebody when they test positive on a drug test. They very
    often will give them an opportunity, get evaluated, you know,
    get help, and then come back to work. That's a very common
    thing.
        Mr. Brat. That is great. Thank you very much. Chairman, I
    yield back.
        Chairman Walberg. I thank the gentleman. I recognize the
    gentlelady from Ohio, Ms. Fudge.
        Ms. Fudge. Thank you very much, Mr. Chairman. And I am
    really happy that we are having this kumbaya moment right now,
    that we have such a religious group. I too am very religious
    and I thank you for praying the victims of the 18th school
    shooting this year. You know, the Bible tells us to watch as
    well as pray. So we should be knowing and talking about what is
    going on around us. The Bible tells us that we are our
    brother's keeper. The Bible tells us that we should take care
    of our children and what Jesus thinks about those who don't.
    You know, we talk about praying is enough, it is not enough. We
    talk about the mentally ill. There are mentally ill people in
    every industrialized nation in the world and there is no other
    country that has these kinds of shootings. You know why?
    Because they do not have access to weapons of mass destruction
    by way of assault rifles, AR-15s, AK-47s. They don't have them.
    That is the difference. Yet, we talk about mental health is the
    problem, but we defund mental health treatment, we defund
    counselors in schools. So you can't have it both ways. Either
    you care about these kids or you do not. Praying doesn't make
    it any different.
        Dr. Andrews, we know that it is not always what happens in
    the world, we know sometimes it is about who it happens to. So
    I remember very clearly when we had a war on drugs and a just
    say no, just because it was crack cocaine and it was affecting
    people in poor and minority and urban communities. Now we are
    all worried about opioids, which I am as well because it is
    ravaging my community, but because it is happening in rural
    communities, in wealthier communities. We talk about it but we
    don't put any money behind. We say we want people to get better
    but we won't pay to treat them. So please help me understand
    what is it that we can do as a Congress to make this situation
    better?
        Dr. Andrews. Absolutely. Thank you for the question. I
    think that one of the things that we learned from the crack
    cocaine epidemic and the war on drugs was that a strong law
    enforcement approach that does not also take seriously the
    importance of a public health perspective and the need for
    treatment is not successful. And it resulted in a mass
    incarceration of many individuals in urban and largely African-
    American communities. And that resulted in devastating impacts
    for their children, their families, and their communities. And
    those are mistakes that we must not repeat. And I think that
    one of the things that is going to be most important moving
    forward is to reduce the stigma around opioid use and to
    connect people to treatment and to provide the resources that
    we need in order to do that successfully. And while I am very
    grateful for the funding that Congress has allocated through
    both the Cures Act as well as the recent budget agreement,
    addiction is a disease that is chronic in nature and that once
    somebody has the disease of addiction they will have to receive
    services to maintain their wellbeing for the rest of their
    lives. And so short-term funding initiatives that last one or
    two or three years will not address the problem in the long-
    term. Insurance coverage to enable people to stay well is going
    to be really key.
        Ms. Fudge. Okay. Just quickly, is it going to help us at
    all if we say to these drug companies, stop marketing opioids
    to doctors' offices and paying them to distribute them? A lot
    of our doctors' offices have become drug dealers. Am I right?
        Dr. Andrews. While this is somewhat out of my area of
    expertise, I have certainly kept up with the reports and I
    think it has been a very problematic trend that these drugs
    have been marketed to physicians over a long period of time
    indicating that they are a safe--
        Ms. Fudge. Dr. Andrews, I am sorry to interrupt you, my
    time is really going.
        Dr. Andrews. That's all right.
        Ms. Fudge. So I think that we are going in the right
    direction. And I would just say to you that the next time
    somebody reports to you with an opioid problem tell them that
    our prayers and our thoughts are with them. See if it heals
    them.
        I yield back.
        Chairman Walberg. I thank the gentlelady and I recognize
    the distinguished chairperson of our full Education Workforce
    Committee, Mrs. Foxx.
        Mrs. Foxx. Thank you very much, Mr. Chairman, and thanks to
    you and Mr. Byrne for organizing this hearing, and also to all
    of the members of the panel. I think you can see this is a
    topic that unfortunately we have a great deal of interest in
    because we know it is impacting so many people. And we very
    much appreciate you all coming here today.
        Ms. Allen, thank you very much for talking about your
    personal experiences with the Committee today and thank you for
    taking steps in your business to decrease the stigma around
    prior drug use and give individuals a second chance. According
    to several studies, individuals who previously used opioids
    have the highest relapse rates of all substances, excluding
    alcohol. This suggests there is still much work to be done even
    after rehabilitation. At your company, what programs do you
    have in place that will help to decrease the likelihood of
    relapse?
        Ms. Allen. Thank you, Dr. Foxx, for your question. Specific
    programs in place, unfortunately, we don't at this time, but we
    have individual instances. Unfortunately, also, the failure
    rate is high, as you suggested. Once again, it's not formal,
    but we watch each other, we pay attention to each other. One
    example I can think of, and I believe is in my written
    testimony, is about an individual who we noticed slipping. We
    tried our best to have conversations. We connected him with an
    outside counselor. We have insurance services that will cover
    those things. But it's a slippery slope and it's a painful
    slope. And as Dr. Andrews suggested, it's a lifelong illness.
    It's an illness. And we were unable to help him and I believe
    he's incarcerated again.
        So we're working on it. It's a journey for us. And I have
    to thank the Committee, the Subcommittee for inviting me
    because out of this will come a lot more programs inside our
    company and inside our community as we learn as well.
        Mrs. Foxx. Thank you very much. Mr. Rhyan, many proactive
    responses to the opioid epidemic came out of necessity,
    starting at the local level. You mentioned the engagement of
    community stakeholders to discuss the local impact of the
    opioid epidemic in Lorain County, Ohio. Can you talk more about
    specific ways employers are getting involved in their local
    communities and how local leaders are playing an important role
    by coordinating with employers and others to address the opioid
    epidemic?
        Mr. Rhyan. Thank you. That's a very important question. And
    being aware of the local circumstances, not only of the
    problems that are going on within the community, but also what
    the resources available there are. Part of our project in
    Lorain County was to go and do an availability and services
    analysis and go out and actually look and say, ``What are the
    services that are available right now and where are they within
    the county?'' Because the services that are available don't
    always line up with where the needs are of the population. And
    so certainly employers that can be aware and make those
    connections ahead of time and be aware of where the needs are
    and then also where the solutions are and where the services
    are available is really important. And to be able to draw those
    connections for their employees as soon as possible helps
    expedite individuals into treatment and helps make that
    treatment more likely that it's going to stick and that they're
    going to actually continue through to recovery.
        Mrs. Foxx. So being prepared in case something happens you
    are saying?
        Mr. Rhyan. Yes, right, absolutely. This is certainly
    something that we need to--employers need to be ready for ahead
    of time. They can't be reactive to this problem anymore.
        Mrs. Foxx. All right. Ms. Russo, we heard Ms. Allen talk
    about how her company is providing resources and assistance to
    employees who are struggling with opioid abuse. What are some
    of the steps that you think that small businesses in particular
    can take, regardless of their size, to begin to address opioid
    abuse in their workplace? Are you familiar with other programs
    that you can share with us?
        Ms. Russo. I think training is a very important thing for
    employers to do, both of their supervisors and the employees. I
    think, you know, many employees don't really understand how
    addictive painkillers are, how dangerous it is if they are
    interacted with alcohol or other types of drugs. I think, you
    know, providing training to employees is helpful. Training
    supervisors on drug policies and how to address drug problems
    in the workplace, I think, is extraordinarily helpful because
    very often supervisors don't know what to do. Having clear
    medical leave policies is very important. Having employee
    assistance plans is very important. Consider changing your drug
    testing policy from terminating everyone, to offering them an
    opportunity to get treatment. Those are some of the things that
    I'm seeing employers do.
        Mrs. Foxx. Thank you very much. My time is up.
        Chairman Walberg. I thank the Chairwoman and I recognize
    the ranking member of the full Committee and gentleman from
    Virginia, Mr. Scott.
        Mr. Scott. Thank you, Mr. Chairman. Mr. Chairman, you
    opened the hearing by talking about the tragedy in Florida and
    the need to do something about school shootings. So, Mr.
    Chairman, it is obvious that the Judiciary Committee is unable
    to hold hearings. They didn't hold hearings even after Sandy
    Hook. And I was wondering if this committee could hold
    hearings, particularly in light of the quote this morning in
    Politico where Secretary DeVos has encouraged Congress to hold
    hearings on school shootings. I was wondering if you could make
    a commitment to hold some hearings in this committee.
        Chairman Walberg. Well, I appreciate the question and I
    certainly will talk with the chairman of the full Committee,
    Ms. Foxx, about that and where we have authority and
    opportunity to assist and move forward in whatever area that
    comes under our jurisdiction. We are certainly open to that.
        Mr. Scott. Thank you, Mr. Chairman.
        Dr. Andrews, you indicated that drug testing is not an
    effective deterrent. Other testimony has suggested that it is a
    good strategy. Could you comment further on why drug testing is
    not an effective strategy to deal with the problem?
        Dr. Andrews. I'd be happy to. As I've mentioned previously,
    addiction is a disease. It is a chronic disease. And one of the
    symptoms of the disease is uncontrollable cravings for a
    substance. And as a result of that, the threat of a drug test
    or random drug testing would not necessarily be successful in
    keeping somebody from using because they have a physiological
    dependence on that substance. The best way to stop people from
    using opioids is to provide treatment, especially medication
    assisted treatment.
        Mr. Scott. Is that reality the reason why the criminal
    justice system as a response is a totally ineffective strategy
    from a cost effective basis?
        Dr. Andrews. Yes, I believe very strongly that a public
    health approach is needed to respond effectively to the opioid
    epidemic. Decades of research document that addiction is a
    disease and it requires treatment in order to help people to
    move into recovery and to maintain recovery.
        Over the past couple of decades science has made incredible
    advances in treatment and we now have medications, such as
    buprenorphine and naltrexone that are very effective in helping
    people to get well. And that has incredible benefits for
    employers who are able to retain people who've made valuable
    contributions to their company.
        Mr. Scott. As you have suggested, that treatment is not
    free and you said one-third of the people pay through the
    Affordable Care Act, either Medicaid expansion or the
    exchanges. One of the Affordable Care Act visions is a list of
    essential benefits where behavioral healthcare, including
    substance abuse treatment, is part of it. You mentioned the
    associated health plans that will allow plans to be written
    without the essential health benefits, how do other initiatives
    that eliminate or reduce the importance of essential health
    benefits, how do they affect the ability to afford substance
    abuse treatment?
        Dr. Andrews. Right. When people purchase a plan that
    doesn't include the consumer protection to cover substance use
    disorder treatment they can find themselves in a position where
    one of their or their family members needs lifesaving treatment
    for opioid use disorder and cannot afford to receive it. In
    those cases their only option is attempt to receive treatment
    from a safety net provider that is funded by federal and state
    block grants. But unfortunately those programs often have very
    long wait lists and people are required to wait weeks and
    months to receive treatment. And we simply do not have that
    kind of margin of error with this particular illness and the
    high risk of overdose and death that is associated with it.
        Mr. Scott. Thank you. And the Affordable Care Act also has
    a prohibition against considering preexisting conditions. If
    someone has had a long period of addiction and buys a policy,
    under present law they can get treatment. If the Affordable
    Care Act and all its protection are repealed, can you say what
    effect the loss of preexisting conditions protection would
    have?
        Dr. Andrews. When people who have an opioid use disorder
    are unable to access treatment due to financial barriers they
    will suffer, their children will suffer, their families will
    suffer. They will have risk of overdose and death as a result.
        Mr. Scott. Thank you, Mr. Chairman.
        Chairman Walberg. I thank the gentleman. Now I recognize
    the gentleman from Wisconsin, Mr. Grothman.
        Mr. Grothman. Thank you. I was just looking a little bit
    about the tragedy yesterday in Florida and, at least if you can
    believe what they say on the internet, the shooter was
    receiving mental health treatment, which reminds us that mental
    health treatment is not all panacea. Sometimes it makes things
    better, sometimes it makes thing worse. You never know, but it
    is something we have got to remember.
        One of my senior staff had a relative who recently had a
    major surgery, was prescribed opiates and, per usual, more
    opiates than they would ever need. It is really a problem with
    the medical establishment, that they have overprescribed these
    things. But when his fellow co-workers found out that they had
    extra opiates they harassed him all the time for them, which is
    kind of amazing. And I wonder is this a common experience that
    you find, that employees who maybe were injured at one time or
    another get harassed by other employees looking for more
    opiates? Anybody heard of that being a problem? No, nobody has.
        Ms. Russo. I have.
        Mr. Grothman. Okay.
        Ms. Russo. I often counsel employers who are dealing with
    employee misconduct issues because they have got employees who
    are selling their oxycontin to co-workers at work. It is a very
    big problem for employers.
        Mr. Grothman. Okay. Yeah, it is a real problem with the
    medical community that they have over prescribed these things.
    And it shows no matter how long you go to school, it doesn't
    give you common sense.
        Next question I have, obviously there is a lot of treatment
    going on already and again and again you hear of people who
    have been in treatment lots of times and it doesn't succeed. So
    it would indicate to me that the last thing we want to do is
    throw money at treatment because, again, bad treatment is
    almost sometimes better than no treatment. Could anybody
    comment on the percentage of times people go in for treatment
    that they stop using opiates? Anybody have a comment on that in
    their experience, in their businesses? Does it work half the
    time, a tenth of the time, 90 percent of the time? Any
    comments?
        Dr. Andrews. I can speak to that. Before we had access to
    evidence-based medications for treatment of opioid use
    disorder, rates of recurrence of use were very high, upwards of
    80 percent. But with the introduction of buprenorphine and
    extended release naltrexone we are seeing much, much higher
    success rates in terms of people being able to maintain--to get
    into recovery and to maintain recovery.
        Mr. Grothman. I am going to cut you off because I have such
    a limited period of time. How many times do you have to use say
    an opiate, say heroin, to become addicted to heroin? Do you
    want to go right down the aisle and you can all give me a
    number?
        Mr. Rhyan. I'm not a medical professional so I don't think
    I should--
        Mr. Grothman. Nobody knows? Anybody have an opinion on
    that?
        Ms. Allen. I have no idea. I've never used opioids.
        Mr. Grothman. Okay, nobody knows.
        Ms. Allen. But I have heard that it doesn't take more than
    once. I've heard people say that the only difference between
    them and me or you is one decision.
        Mr. Grothman. Well, I am not sure that is true. Okay, go
    ahead, Ms. Allen--or Ms.--I am sorry.
        Dr. Andrews. The research suggests that the proportion of
    people who engage in what is called casual opioid use or heroin
    use, about 20 percent of those will proceed on to sort of a
    full-fledged dependence and addiction. So that's what we know
    at present.
        Mr. Grothman. Okay. Okay. Okay, we will leave it at that. I
    give the rest of my time back to the Chair.
        Chairman Walberg. I thank the gentleman. Votes, have they
    been called? 10 minutes left to vote? Well, we will--the
    members have this series of votes. We need to get to the floor.
    But to allow members the opportunity to question the witnesses,
    we will return to the hearing as quickly as possible. I urge
    all members to return here and as soon as we have a sufficient
    number of members we will begin. And so forgive us for having
    to leave you at your seat right now. We will do our best to get
    the votes and then be back.
        We stand in recess.
        [Recess]
        Chairman Walberg. The Subcommittee will come to order. I
    appreciate the witnesses cooling your heels for that period of
    time, including our demonstrations. So we are glad to be back.
        I now recognize the gentlelady from Delaware, Ms. Blunt
    Rochester.
        Ms. Blunt Rochester. Thank you, Mr. Chairman. First, I want
    to thank the panel so much for your testimony and just on so
    many different levels. And I have a few different questions
    that aren't necessarily connected.
        So the first is going to be Ms. Russo. You all talked about
    the--my real question is whether--you know, I assume if it is a
    physically demanding or a dangerous job that it would be
    disproportionally impacted in terms of who is prescribed and
    who might be a part of this epidemic. But I was wondering if
    there are particular industries that you are seeing higher
    incidents of addiction? And also for Dr. Andrews as well.
        Ms. Russo. For me I can only give you anecdotal evidence.
    What I'm seeing is--the highest rate of addiction I'm seeing is
    in the health care industry, mainly because people who work in
    hospitals and clinics have access to drugs. So I deal with a
    lot of health care employers who have employees who are
    addicted. That's just my personal reaction.
        Ms. Blunt Rochester. Great, thank you. Dr. Andrews?
        Dr. Andrews. The available research we have suggests that
    the highest incidence that rates we are seeing are in the
    fields of construction, manufacturing, and mining. And I do not
    think it is coincidental that those are all fields that are
    physically demanding and sometimes dangerous.
        Ms. Blunt Rochester. Thank you. My next question shifts to
    Ms. Allen. I want to really thank you so much for the
    leadership that your company provides, both for the products
    that you produce but also your person centered approach to
    management. And I was wondering if you could talk a little bit
    about the supports that you provide. As you talked about Sonny,
    you know, I wondered about what kind of infrastructure you
    have, whether it is an HR team, a really good HR team. You
    talked about the peer to peer and also just the culture, a
    family culture. But I was more interested also in are there
    specific supports that you provide. If you want to give it in
    writing later, that is fine too.
        Ms. Allen. No, I will be happy to answer that. Thank you.
    One of the things that we have done is we work with some local
    social service agencies. We've worked with other businesses
    around the country to share best practices. And what we've done
    is we work with the social service agencies for the wraparound
    services for our employees. So if they have an issue we can
    refer them. We can help them find the help that they need
    hopefully.
        We were talking at the break, one of the problems in our
    area is that the services are busting at the seams with the
    need and not enough opportunity to provide the services. We
    work with counseling services in our community, we work with
    the healthcare industry, and we work with other businesses just
    to see what, you know, other avenues are out there to help our
    folks.
        Ms. Blunt Rochester. Great. Thank you.
        Ms. Allen. We also--one other thing, if I may, is we work
    closely with the Board of Prisons, both in West Virginia, in
    our area--and we're in Wheeling, which is the northern
    panhandle, so we work closely with the Board of Prisons in the
    Ohio system as well. And so we interact with them and hopefully
    can find reentering citizens that way.
        Ms. Blunt Rochester. Thank you. And then my last question
    is really centered around the whole issue that Mr. Sablan and
    Ms. Fudge touched on in terms of the incidence in terms of
    people of color. I read recently a New York Times article that
    actually said that the opioid crisis is getting worse,
    particularly for black America. That was the title of this New
    York Times article. And in the beginning I think there was an
    under representation because many people of color were not
    being prescribed pain medicine. And now with fentanyl it seems
    to be on the rise. And so I was hoping that, whether it is Dr.
    Andrews, and then, Mr. Rhyan, if you would like to touch on
    that. And we have 30 seconds.
        Dr. Andrews. I'll try to make this quick. Overdose and
    death among African-Americans is on the rise. It is now growing
    faster than it is for white Americans. This problem is
    exacerbated by the fact that African-Americans were under
    represented in Medicaid expansion states. What I mean by that
    is that those states that chose not to expand Medicaid have a
    higher proportion of African-Americans. So at a time when this
    rate is increasing rapidly they are more likely to be in places
    where they will not have access to care if they are low income.
        Ms. Blunt Rochester. Thank you. My time is expired, but I
    would appreciate anything in writing as a follow up.
        Thank you. Thank you, Mr. Chairman.
        Chairman Walberg. I thank the gentlelady. Now I recognize
    the gentleman from Georgia, Mr. Allen.
        Mr. Allen. Thank you, Mr. Chairman. And thank you so much
    for being with us and enduring some of these questions that you
    are getting. I feel like I have got to comment as far as the
    terrible tragedy yesterday. And I just pray that prayers
    continue to flow there because it is the only way that I know
    that we can try to--I mean it is the only way that I can deal
    with things like this. It is just horrible. It is evil at its
    worst and it is just terrible. And my strength comes from Mark
    11:24, ``Therefore I tell you, whatever you ask in prayer,
    believe that you have received it, and it will be yours.'' And
    of course that takes a tremendous amount of faith to do that.
    And there are hundreds of other verses. God promises that if we
    would just believe those that we could correct a lot of these
    issues that we are dealing and talking with here today. And
    that is just my belief and my value system. I cannot change
    you, I cannot change myself. I cannot change anybody. But- and
    as far as the ironic part of this is that we are talking about
    something that is an epidemic here that is highly illegal in
    this country. I mean, we cannot seem to obey the laws we have,
    whether it is immigration or drugs or whatever. So I don't
    know. You know, I think the answer is, you know, what makes up
    your DNA and what you believe.
        To that extent, Ms. Allen--I hope we are related somewhere
    because, I will tell you, I was really impressed with--I am a
    small business owner and had to deal with a lot of these issues
    and had to deal with the drug situation. And, again, did it not
    from my--did it in a compassionate way and tried to help folks
    get well and get back to work. But as far as the percentage of
    your employees that have a drug problem, is it--I mean what--in
    your past, and you have got 300 employees now, what percent are
    really have an issue with this would you say?
        Ms. Allen. Well, Congressman Allen, we believe--we don't
    ask the question necessarily. There is conversation, but we
    don't necessarily ask it. It is our estimation that between 20-
    25 percent of our total workforce has some kind of a checkered
    past.
        Mr. Allen. Right, okay. So they have had to deal with this
    issue in the past?
        Ms. Allen. Themselves. Their families I can't even speak
    to.
        Mr. Allen. Is there any evidence that--obviously you are a
    great company--And like I said, I have 12 grandchildren and we
    do, I use a lot of your products.
        Ms. Allen. Thank you so much.
        Mr. Allen. Yeah, I mean it is the best babysitter in the
    world, let me tell you. But you have got a great company and
    obviously you care deeply for your employees and they care
    deeply for you and that company. And you have had an amazing
    track record in rehabilitation. And I don't know what, you
    know, those that you have lost that you haven't been able to
    save from this problem, but would the fact that you are able to
    give somebody a good job making a great product and the
    opportunity for them to give themselves the dignity and the
    empowerment that they deserve as a human being on this earth,
    would that have something to do with them recovering from this
    horrible addiction?
        Ms. Allen. 100 percent, absolutely.
        Mr. Allen. 100 percent? Yeah.
        Ms. Allen. Absolutely it would. The ability to have a job
    and feel secure in having the ability to take care of yourself,
    let alone your family, to get out of homelessness, all those
    things require money and you get money from having a job. And
    so to provide somebody the opportunity to have the sense of
    pride and the sense of self-worth and the sense of dignity, to
    be able to walk home with a paycheck, that feels good, that
    feels really good to them. And for us to be able to provide
    that, we're proud of that. We're very proud of that. Are there
    failures? Absolutely. Does that stop us? No. We look for people
    who can fit inside our value system. And just because some
    people made a bad decision or a bad choice, doesn't mean they
    still aren't great people and have the opportunity to re-prove
    themselves.
        Mr. Allen. We all fall short, we all fall short.
        Ms. Allen. Absolutely. Because we've all made bad decision.
        Mr. Allen. Mr. Rhyan, do you have any research that--I got
    20 seconds--any research that might help us with, okay, how do
    we actually fix this? You know, what is the best way to deal
    with these things?
        Mr. Rhyan. Yeah, I think, as I said in my oral and written
    testimony, looking at this both from a treatment and a
    prevention perspective is really important. And I think
    employers that can play a role in providing treatment and
    recovery services is important, but also thinking about how
    they can act on the prevention side, and really limiting the
    opioids that are going into their environment and also helping
    their employees not get an addiction before it starts.
        Mr. Allen. Thank you all so much. And I yield back.
        Chairman Walberg. I thank the gentleman. Now I recognize
    the gentlelady from Oregon who has spent a lot of time recently
    listening to these concerns, Ms. Bonamici.
        Ms. Bonamici. I have. And thank you, Mr. Chairman. And I
    wanted to start also by making a comment, and with following up
    to Mr. Allen's comment, you know we have all been praying in
    our ways. We prayed after Sandy Hook, we prayed after Pulse, we
    prayed after Tamaqua Community College, we prayed after Las
    Vegas, after the church in Texas, and of course the nation is
    all praying, everybody in his or her own way after yesterday.
    But kids are still being murdered in schools. Prayers are not
    enough. And I want to align myself with Mr. Scott's call. And I
    don't always agree with Secretary DeVos, but I agree with her
    this morning. We have to have hearings to find out how we can
    keep our kids safe in school. I am a mom, my kids are grown,
    but I cannot imagine what those parents are going through.
        So, thank you, Mr. Walberg. Yes, I have just had five
    listening sessions around northwest Oregon with health care
    providers, people in recovery, law enforcement, and of course
    employers. I appreciate so much of the testimony here today and
    understand that work and our personal lives are so intertwined.
    Ms. Allen, thank you so much for setting that example. We have
    a business in my district, Beaverton Bakery, that has a second
    chance program. They work with our drug treatment court. And
    when we acknowledged them recently I prepared for an onslaught
    of criticism, but the response was overwhelmingly positive. So
    I think we will see that as more and more businesses do what
    you are doing.
        Mr. Rhyan and Dr. Andrews, you both mentioned drug disposal
    as important tools, and that is something that has come up in
    my listening sessions. There just are not enough options for
    people. It is one important step. There are not enough options
    for people to get rid of their unused prescription pills. So
    can you please elaborate about the role that employers could
    play in providing a solution? And briefly because I do have
    another question. Mr. Rhyan?
        Mr. Rhyan. Sure. I think you can look at Walmart as a great
    example. And they have proposed offering these sites both for
    their employees and for customers as well. And so I think
    employers absolutely can step up to do that, because you're
    right, not all local police stations have this. I know many do,
    but certainly many don't.
        Ms. Bonamici. And not to interrupt, but a lot of my
    constituents don't feel comfortable walking in to a police
    station saying I want to get rid of my unused drugs. I have a
    significant Latino population, minority populations. They are
    just not comfortable walking into a police station with drugs.
    So we have to have alternatives for people to get rid of those
    pills.
        Dr. Andrews, do you have anything to add?
        Dr. Andrews. I think that this is an incredibly important
    issue. Safe drug disposal must be an important component of
    prevention efforts around the opioid epidemic. I think that,
    you know, integrating safe disposal into places like
    pharmacies, primary care, places that are not either
    stigmatized or present criminal threats, and allow people to
    feel comfortable getting rid of those unwanted drugs is really
    key.
        Ms. Bonamici. Thank you. Those are logical. I want to move
    on--as the clock goes down. Mr. Rhyan, you mentioned parity for
    coverage of behavioral health. And one of the issues that has
    come up frequently is alternative treatments. We have at our
    Oregon Health Sciences University a great pain management
    clinic, but often times alternative treatments, whether it be
    physical therapy, massage therapy, acupuncture, they are not
    covered. And so they are not prescribed and instead opioids are
    prescribed. So are there good reasons for employers to make
    sure these alternative treatments are covered in the plans they
    offer? And how could we expand the number of employers who are
    doing that?
        Mr. Rhyan. Yes, absolutely. Employers should be involved
    and engaged in the insurance that they're offering to their
    employees and making sure that these alternatives are
    available. I think we've realized the risk of prescribing an
    opioid for chronic pain and the risk of addiction that occurs
    from that is very costly to that employer. And so making these
    alternatives available has the potential to save that employer
    money and is a better option for the employee themselves.
        Ms. Bonamici. Dr. Andrews, anything to add?
        Dr. Andrews. Yes. I would add to that there's research that
    suggests that opioids are not effective for chronic pain
    management and that we have to start funding both services as
    well as medications that are going to be more effective.
        Ms. Bonamici. Alternatives. And, Mr. Rhyan, you know, I
    have heard about sometimes fear of job loss or income loss.
    Somebody with a substance abuse disorder might delay or forego
    getting treatment. So how could comprehensive job protected
    paid leave allow workers to seek treatment and support those in
    their family who many need treatment?
        Mr. Rhyan. I think both of those options are very
    important. The evidence that we've seen from Lorain County and
    the other work that we've done is that employers that offer
    those programs tend to see very positive results from those
    cases. And certainly I think you can give examples as well,
    that shows a strong benefit and is good for all parties.
        Ms. Bonamici. Thank you. And, again, Mr. Chairman, thank
    you so much, and Ranking Member, for holding this hearing. It
    has been very informative and I yield back.
        Chairman Walberg. I thank the gentlelady. And now without
    objection I would like to recognize for questioning, five
    minutes of questioning, the gentleman from Pennsylvania who
    does not serve on the Subcommittee but who is in the full
    Education Workforce Committee and has a background in medical
    profession and has great interest in this issue, Mr. Thompson.
        Mr. Thompson. Well, thank you, Chairman. First of all, I
    appreciate not being objected to.
        Chairman Walberg. I didn't hear objection.
        Mr. Thompson. Okay. I am not going to raise one, so. And
    thank you to the panelists who are here. I mean this is the
    public health crisis of our generation. I have also conducted
    opioid roundtable listening sessions throughout my
    congressional district and continue to do that. I represent
    about a quarter of geographically the state of Pennsylvania, a
    lot of rural communities. The CDC, in October of 2017,
    published a report showing how disproportionately this is
    hitting rural America. This is hitting all populations, all
    households, all zip codes, all socioeconomic levels of living.
        I would caution against a narrow focus on opioids, because
    what we need to be looking at is addictive behaviors. I have
    communities, and I heard these stories where it was opioids and
    then because of what happened with heroine and opioids and some
    of the things that were put into it, the number of deaths, the
    number of focus on it, that the users shifted, they actually
    went to the treatment, suboxone, and utilized that illegally.
    They have gone back to meth because of all the factors.
    Whatever we do, we cannot do a narrow focus, Mr. Chairman. We
    need to do this so it applies to all behaviors.
        Most recently I met with folks from--some wonderful people
    that work in the prison system. They talked about this
    frightening thing called--and I am not going to go into it--but
    K2, which is--could not believe the stories they told with
    that. But some of the things I heard about though, was a lack
    of treatment. We have since the Great Society--there was a push
    back then to deinstitutionalize the Great Society. I think
    their push, the outlawing in 1965 of any kind of use of
    Medicaid in facilities larger than 16 people. That was a huge
    mistake. As opposed to improving those facilities so that they
    actually met needs, they just arbitrarily said you just can't
    go there. And I believe, as I talked with family members and
    people in the community, we have very limited options. We have
    drive-through treatment today, which doesn't work. And we need
    long-term treatment.
        And I was very pleased, the Trump administration's actually
    was the first one since the Great Society of 1965 who
    encouraged the states to exercise their waivers for Medicaid to
    be able to, you know, to be able to use those in facilities
    that have more than 16 beds. That is what we need. In a rural
    part of America, which is where I am from, you know, it is
    small facilities. And we have very limited options.
        And also, I am pleased with the support. Under President
    Obama we put $1 billion into this battle through the Cures Act,
    and under President Trump, just last week, we put $6 billion
    into this battle. You know, we need to continue to be
    attentive.
        So workforce, like many national crises the opioid epidemic
    is multifaceted. We have taken steps to respond and I am really
    appreciative of your comments.
        The President's Commission on Combating Drug Addiction and
    the Opioid Crisis released recommendations in November. And
    while the Commission's recommendations were vast, the only
    notable recommendation related to workforce addressed the
    shortage and the lack of training for substance abuse and
    medical training professional.
        So, very quick, in the time I have left, do you agree with
    the workforce recommendation by the Commission? And what
    further workforce recommendations were you anticipating? That
    is jump ball. Go for it, whoever would like to take that on.
        Dr. Andrews. I think that training is absolutely key,
    particularly around safe prescribing of opioids, and
    particularly for physicians and other prescribers of drugs. We
    have a series of excellent guidelines that have been
    established by the CDC to help physicians make good choices
    about safe prescribing, but we need to do more in terms--
        Mr. Thompson. But how about on the treatment side?
        Dr. Andrews. Mm-hmm. Right.
        Mr. Thompson. Because, you know, I understand responding to
    the crisis and preventing the problem.
        Dr. Andrews. Oh, absolutely.
        Mr. Thompson. But I am finding the key now really is--the
    key thing that we are not doing that we need to do is making
    sure that we have the long-term effective treatment to help
    people get, you know, get--once you are an addict I understand
    you always carry part of that, but how do we deal with that and
    help people live healthy lives post addiction?
        Dr. Andrews. Well, I think every state in the country
    should apply for a waiver for the IMD exclusion.
        Mr. Thompson. Agreed.
        Dr. Andrews. And I think that we need to, you know, train
    licensed professionals to provide these services. We've been
    making strides towards that end, but there is more to be done.
        Mr. Thompson. Thank you. Thank you, Chairman.
        Chairman Walberg. I thank the gentleman. And I would like
    to thank Mr. Rhyan, Ms. Allen, Dr. Andrews, Ms. Russo. Thank
    you for providing your insights to our panel today. A number of
    them talked to me on the way back to votes that they were so
    disappointed we just couldn't have carried it on, and schedules
    get in the way. One even said she is going to get the tape of
    it and see the ending. So you have been a great help to us and
    this is all a process that we go through.
        Seeing no other members that have questions I now turn to
    Ranking Member Takano for his closing comments.
        Mr. Takano. Thank you, Mr. Chairman. And I want to thank
    you again for hosting this important hearing, and the witnesses
    for providing their testimony.
        The opioid epidemic, and substance abuse more broadly, has
    been felt in every corner of this country. The impact is never
    limited to just one individual, it affects families, friends,
    and even employers. More than half of adults struggling with
    substance abuse were employed full-time in 2012. In a recent
    survey from the National Safety Council found that 70 percent
    of employers have felt the negative effects of prescription
    drug usage, including absenteeism, impaired or decreased job
    performance, and near misses or injuries. If we are going to
    make any progress in addressing the opioid epidemic and
    addressing substance abuse disorders in general, our workplaces
    must have policies that support affected workers.
        Now as Ranking Member Sablan said, access to comprehensive
    health coverage is imperative for workers with substance abuse
    disorders. Efforts to rollback protections or reduce the
    quality of health coverage denies them the help they need to
    move towards recovery. Workers affected by substance abuse also
    benefit from strong workplace policies that prevent addiction,
    allow them to take time to seek recovery, and help them reenter
    the workforce.
        As with many of the problems this committee seeks to
    tackle, preventative efforts will save lives. Employees who
    sustain work-related injuries and are treated within the
    workers' compensation system are often prescribed opioid pain
    medications. In 2011 more than 25 percent of cost from worker's
    compensation prescription drug claims were for opioid pain
    medications. Employers can take active steps to reduce the risk
    of workplace injuries that lead to opioid use. Injury and
    illness prevention programs require employers to work with
    their employees to proactively find and fix hazards. These
    programs required or encouraged by 34 states, including my home
    state of California, are proven to reduce injuries on the job.
        At work, when employees do suffer from a substance abuse
    disorder they often need to take extended periods of time to
    seek treatment. But workers who fear losing their jobs or
    missing a paycheck may delay or forego needed treatment.
    Currently, eligible workers who take leave under the Family and
    Medical Leave Act for substance abuse treatment are protected
    from retaliation. Unfortunately, 60 percent of workers are not
    eligible for leave under the FMLA. What is more, workers who
    are actually eligible often cannot afford a missed paycheck.
    According to a 2012 survey, 46 percent of FMLA eligible workers
    did not take leave because they could not afford to take unpaid
    time off. Paid family leave, as provided under the Family Act
    can provide crucial support for workers seeking treatment.
        Now, as we have recently seen, Republican proposals for
    paid leave, and we have actually seen Republican proposals for
    paid leave, and this is very encouraging. As we consider them,
    I think we should ask if these proposals would guarantee
    workers the ability to take leave for substance abuse
    treatment.
        We also know that the opioid crisis and the substance abuse
    disorders in general can lead to people leaving the workforce.
    An estimated 20 percent of men's and 25 percent of women's
    decreased labor force participation between 1999 and 2015 can
    be attributed to the increase in opioid prescriptions. When we
    hear these statistics it becomes clear how important it is for
    our employers to implement policies that break down barriers
    for impacted workers trying to reenter the workforce. For
    instance, while there is wide use of workplace drug testing
    policies there is little evidence that they actually are
    effective. Likewise, employers should reconsider hiring
    practices and policies for those with a criminal record. Ban
    the box policies can ensure employers first consider a worker's
    ability to do the job.
        To put it mildly, our country has had inconsistent
    responses to drug epidemics affecting our communities. But if
    we have learned anything, it is that we should try to rely on
    evidence base approaches to support those who are impacted.
    Strong sentiment and feelings of support are not enough.
    America's employers must step up to the plate and implement
    strong policies that support national efforts to address
    substance abuse.
        Thank you again, Mr. Chairman, for this hearing. Thank you
    to the witnesses. And I yield back my time.
        [The statement of Mr. Takano follows:]

    Prepared Statement of Hon. Mark Takano, Ranking Member, Subcommittee on
                             Workforce Protections

        I want to thank the Chair for hosting this important hearing. The
    opioid epidemic - and substance abuse more broadly - has been felt in
    every corner of this country.
        The impact of addition is never limited to just one individual. It
    is affect families, friends, and even employers.
        More than half of adults struggling with substance abuse were
    employed full-time in 2012. And a recent survey from the National
    Safety Council found that 70 percent of employers have felt the
    negative effects of prescription drug usage, including absenteeism,
    impaired or decreased job performance, and near misses or injuries.
        If we are going to make any progress in addressing the opioid
    epidemic and addressing substance abuse disorders in general, our
    workplaces must have policies that support affected workers.
        As Ranking Member Sablan has said, access to comprehensive health
    coverage is imperative for workers with substance abuse disorders.
    Efforts to roll back protections, or reduce the quality of health
    coverage, denies them the help they need to move towards recovery.
        Workers affected by substance abuse also benefit from strong
    workplace policies that prevent addiction, allow them take time to seek
    recovery, or help them re-enter the workplace.
        As with many of the problems this committee seeks to tackle,
    preventative efforts will save lives.
        Employees who sustain work-related injuries, and are treated within
    the workers' compensation system, are often prescribed opioid pain
    medications. In 2011, more than 25 percent of cost from workers'
    compensation prescription drug claims were for opioid pain medications.
        Employers can take active steps to reduce the risk of the workplace
    injuries that lead to opioid use. Injury and Illness Prevention
    Programs require employers to work with their employees to proactively
    find and fix hazards. These programs, required or encouraged by 34
    states, including my home state of California, are a proven way to
    reduce injuries on the job.
        At work, when employees do suffer from a substance abuse disorder,
    they often need to take extended periods of time to seek treatment. But
    workers who fear losing their jobs or missing a paycheck may delay or
    forgo needed treatment.
        Currently, eligible workers who take leave under the Family and
    Medical Leave Act for substance abuse treatment are protected from
    retaliation. Unfortunately, sixty percent of workers are not eligible
    for leave under the FMLA. What's more, workers who are actually
    eligible often cannot afford a missed paycheck. According to a 2012
    survey, 46 percent of FMLA-eligible workers did not take leave because
    they could not afford to take unpaid time off. Paid family leave, as
    provided under the FAMILY Act, can prove crucial for workers seeking
    treatment.
        We have recently seen Republican proposals for paid leave, and this
    is encouraging. As we consider them, I think we should ask if these
    proposals would guarantee workers the ability to take leave for
    substance abuse treatment.
        We also know that the opioid crisis, and substance abuse disorders
    in general, can lead to people leaving the workforce. An estimated 20
    percent of men's and 25 percent of women's decreased labor force
    participation between 1999 and 2015 can be attributed to the increase
    in opioid prescriptions. When we hear these statistics, it becomes
    clear how important it is for our employers to implement policies that
    break down barriers for impacted workers trying to re-enter the
    workforce.
        For instance, while there is wide use of workplace drug testing
    policies, there's little evidence that they are actually effective.
    Likewise, employers should reconsider hiring practices and policies for
    those with a criminal record. Ban the box policies can ensure employers
    first consider a worker's ability to do the job.
        To put it mildly, our country has had inconsistent responses to
    drug epidemics affecting our communities. But if we've learned
    anything, it is that we should rely on evidence-based approaches to
    support those impacted. Strong sentiment and feelings of support are
    not enough. America's employers must step up to the plate and implement
    strong policies that support national efforts to address substance
    abuse.
        I thank the witnesses for taking the time to testify today. Thank
    you. I yield back my time.
                                     ______

        Chairman Walberg. I thank the gentleman, appreciate his
    words. This was an important hearing. This hopefully will lead
    to further considerations, hopefully will lead to compassionate
    responses, sensitivity to the issue of concerns on both sides,
    on the issue of employee with a need for something to deal with
    chronic pain, for the employee who has become addicted to a
    substance, an ability to look at their needs and find
    cooperative solutions. On the other side, to look to the
    employer, to make sure that we applaud the employers who are
    trying their best to find a way to work with the problem and
    see it as an opportunity to grow a family, or a tribe, as you
    mentioned, Ms. Allen, in your experience. That we encourage
    employers by allowing a great amount of latitude and
    flexibility, to work with their own employee group and not have
    a one-size-fits-all that sometimes becomes extremely costly and
    unproductive, but also have some framework in place that does
    the encouragement that is necessary to find solutions that at
    least go as far as possible in making things work.
        I think as well, my colleagues would agree, that while we
    look at opioid heroine abuse, as was mentioned by Mr. Thompson,
    it is broader than that. Because if it goes from there, it will
    go to something else, and we need to be prepared for that as
    well.
        And also in the process, I might also suggest that we
    develop a recommitment to a society that shares some common
    values that impact in a positive way our nation, our thought
    processes, and encourage decency and order, compassion and
    caring, and commitment to responsibility as well as
    accountability also.
        It is a big challenge, but this country has met challenges
    before. I remember reading in history, over and over again, of
    times when our framers and founders ultimately locked horns and
    just could not come to a solution, knelt in prayer, ultimately
    got up and did things. Faith and works together make an impact.
        So thank you for being with us today. Thanks to the
    Committee. And having no other thing to come before us, I
    declare it adjourned.
        [Whereupon, at 12:41 p.m., the subcommittees were
    adjourned.]

                                     [all]