[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]