[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
THE ROLE OF FEDERAL HOUSING AND
COMMUNITY DEVELOPMENT PROGRAMS
TO SUPPORT OPIOID AND SUBSTANCE
USE DISORDER TREATMENT AND RECOVERY
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON
HOUSING AND INSURANCE
OF THE
COMMITTEE ON FINANCIAL SERVICES
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
AUGUST 16, 2018
__________
Printed for the use of the Committee on Financial Services
Serial No. 115-112
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
__________
U.S. GOVERNMENT PUBLISHING OFFICE
31-572 PDF WASHINGTON : 2018
-----------------------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Publishing Office,
http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,
U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free).
E-mail, [email protected].
HOUSE COMMITTEE ON FINANCIAL SERVICES
JEB HENSARLING, Texas, Chairman
PATRICK T. McHENRY, North Carolina, MAXINE WATERS, California, Ranking
Vice Chairman Member
PETER T. KING, New York CAROLYN B. MALONEY, New York
EDWARD R. ROYCE, California NYDIA M. VELAZQUEZ, New York
FRANK D. LUCAS, Oklahoma BRAD SHERMAN, California
STEVAN PEARCE, New Mexico GREGORY W. MEEKS, New York
BILL POSEY, Florida MICHAEL E. CAPUANO, Massachusetts
BLAINE LUETKEMEYER, Missouri WM. LACY CLAY, Missouri
BILL HUIZENGA, Michigan STEPHEN F. LYNCH, Massachusetts
SEAN P. DUFFY, Wisconsin DAVID SCOTT, Georgia
STEVE STIVERS, Ohio AL GREEN, Texas
RANDY HULTGREN, Illinois EMANUEL CLEAVER, Missouri
DENNIS A. ROSS, Florida GWEN MOORE, Wisconsin
ROBERT PITTENGER, North Carolina KEITH ELLISON, Minnesota
ANN WAGNER, Missouri ED PERLMUTTER, Colorado
ANDY BARR, Kentucky JAMES A. HIMES, Connecticut
KEITH J. ROTHFUS, Pennsylvania BILL FOSTER, Illinois
LUKE MESSER, Indiana DANIEL T. KILDEE, Michigan
SCOTT TIPTON, Colorado JOHN K. DELANEY, Maryland
ROGER WILLIAMS, Texas KYRSTEN SINEMA, Arizona
BRUCE POLIQUIN, Maine JOYCE BEATTY, Ohio
MIA LOVE, Utah DENNY HECK, Washington
FRENCH HILL, Arkansas JUAN VARGAS, California
TOM EMMER, Minnesota JOSH GOTTHEIMER, New Jersey
LEE M. ZELDIN, New York VICENTE GONZALEZ, Texas
DAVID A. TROTT, Michigan CHARLIE CRIST, Florida
BARRY LOUDERMILK, Georgia RUBEN KIHUEN, Nevada
ALEXANDER X. MOONEY, West Virginia
THOMAS MacARTHUR, New Jersey
WARREN DAVIDSON, Ohio
TED BUDD, North Carolina
DAVID KUSTOFF, Tennessee
CLAUDIA TENNEY, New York
TREY HOLLINGSWORTH, Indiana
Shannon McGahn, Staff Director
Subcommittee on Housing and Insurance
SEAN P. DUFFY, Wisconsin, Chairman
DENNIS A. ROSS, Florida, Vice EMANUEL CLEAVER, Missouri, Ranking
Chairman Member
EDWARD R. ROYCE, California NYDIA M. VELAZQUEZ, New York
STEVAN PEARCE, New Mexico MICHAEL E. CAPUANO, Massachusetts
BILL POSEY, Florida WM. LACY CLAY, Missouri
BLAINE LUETKEMEYER, Missouri BRAD SHERMAN, California
STEVE STIVERS, Ohio STEPHEN F. LYNCH, Massachusetts
RANDY HULTGREN, Illinois JOYCE BEATTY, Ohio
KEITH J. ROTHFUS, Pennsylvania DANIEL T. KILDEE, Michigan
LEE M. ZELDIN, New York JOHN K. DELANEY, Maryland
DAVID A. TROTT, Michigan RUBEN KIHUEN, Nevada
THOMAS MacARTHUR, New Jersey
TED BUDD, North Carolina
C O N T E N T S
----------
Page
Hearing held on:
August 16, 2018.............................................. 1
Appendix:
August 16, 2018.............................................. 35
WITNESSES
Thursday, August 16, 2018
Boggs, David, President and Chief Executive Officer, Opportunity
for Work and Learning.......................................... 8
Fletcher, Hon. Ernie, Former Governor of Kentucky, and Founder of
Recovery Kentucky.............................................. 5
King, Edwin, Executive Director and Chief Executive Officer,
Kentucky Housing Corporation................................... 10
Minton, Lisa, Executive Director, Chrysalis House................ 12
Robinson, Tim, Founder and Chief Executive Officer, Addiction
Recovery Care.................................................. 13
Thomas, Jerod, President and Chief Executive Officer, Shepherd's
House.......................................................... 15
Walsh, Sharon L., Director of the Center on Drug and Alcohol
Research and Professor, Behavioral Science and Psychiatry,
University of Kentucky......................................... 17
APPENDIX
Prepared statements:
Boggs, David................................................. 36
Fletcher, Hon. Ernie......................................... 40
King, Edwin.................................................. 49
Minton, Lisa................................................. 52
Robinson, Tim................................................ 55
Thomas, Jerod................................................ 59
Walsh, Sharon L.............................................. 64
THE ROLE OF FEDERAL HOUSING AND
COMMUNITY DEVELOPMENT PROGRAMS TO
SUPPORT OPIOID AND SUBSTANCE USE
DISORDER TREATMENT AND RECOVERY
----------
Thursday, August 16, 2018
U.S. House of Representatives,
Subcommittee on Housing
and Insurance,
Committee on Financial Services,
Washington, D.C.
The subcommittee met, pursuant to notice, at 9:10 a.m., in
Courtroom A, U.S. District Court of the Eastern District of
Kentucky, 101 Barr Street, Lexington, Kentucky, Hon. Sean P.
Duffy presiding.
Present: Representative Duffy
[presiding].
Also present: Representatives Barr and Guthrie.
Mr. Duffy. The Subcommittee on Housing and Insurance will
come to order. Today's hearing is entitled, ``The Role of
Federal Housing and Community Development Programs to Support
Opioid and Substance Use Disorder Treatment and Recovery.''
Without objection, the Chair is authorized to declare a recess
of the Subcommittee at any time. Without objection, all Members
will have 5 legislative days within which to submit extraneous
materials to the Chair for inclusion in the record. Without
objection, Members who are not Members of this Subcommittee may
participate in today's hearing for the purpose of making an
opening statement and questioning the witnesses.
The Chair now recognizes himself for an opening statement.
I want to thank our witnesses for joining us as we continue
to look at how existing Federal Government programs can be
utilized to combat opioid addiction and substance abuse. Today,
we will be focused on programs run by HUD (U.S. Department of
Housing and Urban Development) that help low-income families
and the poverty stricken.
I want to thank Mr. Barr for hosting us in the fine city of
Lexington and commend his leadership on the issue of opioid
addiction and substance abuse, something that impacts the
entire Nation. This crisis is not going away and it is only
getting worse in some areas of our country. According to a 2016
report by the U.S. Surgeon General, 1 in 7 Americans will face
substance addiction.
Opioids are now at the forefront of the fight against
substance abuse.
On March 29 of last year President Trump signed an
Executive Order to establish the President's Commission on
Combating Drug Addiction and the Opioid Crisis and the House
began its work by moving legislation. We have passed 50 bills
related to addressing the opioid crisis ranging from treatment
and recovery, to prevention, to the THRIVE (Transitional
Housing for Recovery in Viable Environments) Act, championed by
Chairman Barr.
Mr. Barr's bill recognizes that sometimes you have to use
resources outside of traditional rehab programs to treat
addicts and help them prepare for becoming a productive member
of society.
The THRIVE Act would create a program setting aside 10,000
housing choice vouchers for individuals suffering from
addiction. Those people would be able to use vouchers with
transitional housing nonprofits that focus on maintaining
sobriety, teaching valuable skills for jobs, and obtaining
employment as they transition back into society. They'll have
24 months to complete the treatment program but most
importantly are able to do so in a drug- and alcohol-free,
clean, safe, and supportive structured environment.
I know some of you will be commenting on how this bill
would work in implementation but Mr. Barr's bill is just one
idea. You are the ones out there dealing with this through your
organizations.
We want to hear your ideas.
Mr. King, you mention in your testimony needing the
flexibility to meet specific needs at the local level by
addressing the 20 percent limitation on tenant-based rental
assistance for specific properties.
Ms. Minton, you mentioned Continuum of Care and the
reallocation process to create new projects.
Mr. Thomas, you talk about a limited expansion of vouchers
for graduates of THRIVE-based programs.
Dr. Walsh, your testimony describes what you are doing with
the First Bridge Clinic and the PATHWAYS programs.
These are the ideas we need to hear about that can help us
to combat the opioid epidemic with government programs already
in place.
I look forward to today's discussion as it's one of the
most important issues we should be addressing today.
I now recognize the gentleman from Kentucky, Mr. Barr, the
Chairman of the Subcommittee on Monetary Policy and Trade, for
an opening statement.
Mr. Barr. Thank you, Chairman Duffy, and thank you to the
Housing and Insurance Subcommittee for calling this hearing
today in my home State of Kentucky, which is truly on the front
lines of the opioid crisis.
I'd also like to thank my colleague from the Kentucky
delegation, Congressman Brett Guthrie for joining our Financial
Services hearing today. Mr. Guthrie has been a leader on opioid
issues on the House Energy and Commerce Committee and we are
fortunate to have him here today to offer his insight.
We all know that the opioid epidemic is a major health
crisis that has impacted every community and every
congressional district. Kentucky has the third highest overdose
mortality rate in the country. Last fall, President Trump
declared a National Public Health Emergency and Congress
recently passed a historic package of legislation to address
the opioid epidemic through research, treatment, and
prevention.
H.R. 6, the SUPPORT (Substance Use-Disorder Prevention that
Promotes Opioid Recovery and Treatment) for Patients and
Communities Act that was passed in the House this summer,
builds upon past resources authorized and funded by Congress
including the 21st Century Cures Act and the Comprehensive
Addiction and Recovery Act. I was also proud to support the
Consolidated Appropriations Act earlier this year that
appropriated $4 billion, the largest Federal investment to
date, to address the opioid epidemic.
But there is more work to be done. Over 115 Americans
continue to die every day from opioid overdoses. We cannot
continue to focus our Federal efforts on prevention and
treatment without looking toward long-term recovery through
housing, job placement, financial literacy, and life skills
training.
Too many individuals find themselves with limited housing
choices after completing in-patient rehabilitation and are
forced into housing situations where they are surrounded by
people using the same illegal substances that they went to
rehab to stop using. This perpetuates the cycle of addiction
and prevents individuals from rising above substance abuse.
The opioid epidemic has also presented a major issue for
workforce development and job placement. Local employers I meet
with regularly in Kentucky are struggling to find workers to
fill even low-skill jobs. According to the CDC, the opioid
epidemic's cost to our economy now exceeds $1 trillion.
I was proud that H.R. 6, the opioid package which passed
the House earlier this year, included my legislation, H.R. 5735
the Transitional Housing for Recovery in Viable Environments or
the THRIVE Act. This bill would allow a limited number of
Section 8 Housing Choice Vouchers to be allocated directly to
transitional housing non-profits that have evidence-based
models of recovery and life skills training. I am hopeful that
the Senate will act swiftly to pass this critical legislation.
I have also introduced H.R. 5736 the Comprehensive
Addiction Recovery through Effective Employment and Reentry, or
CAREER (Comprehensive Addiction Recovery through Effective
Employment and Reentry) Act, which would address the decline in
workforce participation as a result of the opioid epidemic by
encouraging local businesses and treatment centers to form
partnerships to secure job training, employment, and housing
options for individuals in recovery. This legislation would
also give States more flexibility to direct Federal funds
through the Community Development Block Grant (CDBG) to local
recovery initiatives. I am grateful to Leader McConnell for
introducing the Senate companion to this legislation.
Meaningful employment and a safe place to live are key to
helping individuals maintain sobriety and rise above poverty.
Today you will hear from several non-profit, government, and
academic experts who are on the frontlines of the opioid
epidemic in Kentucky. They will offer their unique perspectives
on ways our Federal housing and community development programs
could be improved or further utilized to fight the opioid
epidemic.
Reforms to these programs and greater investment in long-
term recovery would save American lives as well as taxpayer
funds in the long run by helping more individuals rise above
addiction and poverty.
Thank you and I yield back.
Mr. Duffy. Thank you Mr. Barr.
I now recognize Mr. Guthrie for an opening statement.
Mr. Guthrie. Thank you Mr. Duffy, and thank you all for
being here today. I have heard countless stories of the awful
effects the opioid epidemic has had on families, communities,
and the overall workforce. I have been working hard in my
committee, the Energy and Commerce Committee, to pass
meaningful legislation that will stop this awful epidemic. The
SUPPORT bill, H.R. 6 which includes over 50 pieces of
legislation is currently pending before the Senate. I am
hopeful the Senate will act quickly to provide relief to so
many suffering Americans. Most of the 50-something bills have
come through our committee. And a lot of it comes from hearing
from people like you, the witnesses here today.
I wish there was one single bill we could pass and it would
make the problem go away. It is just not that simple. I wish
that it was. It is very complicated. And when we hear from
people like you--and I have heard over the last several days
even stuff we need to improve in legislation that has already
been passed out of the House and into the Senate. We do hear
the insights because you all are the experts, you all are the
ones on the frontlines dealing with it, and we are trying to--
where there are roadblocks, we are trying to get flexibility,
we are trying to move things forward.
And it is very appropriate we are having this hearing in
this community today. I was in Elizabethtown about 3 or 4 days
ago going through a recovery center, and the person who was
walking me through said basically we get them here in residence
for 30 days, and we can control that environment. Some of them
leave and whatever, but for the most part, we can get them
through our 30-day program because we have control. They are in
our environment.
He said the biggest gap is the sober-living piece, and so
it really struck me. I said, well, we are having a hearing on
something that Congressman Barr has made great efforts and
great strides to make sure the sober living piece is, one,
known throughout--the issue needs to be dealt with and, one,
hopefully given the tools using money that is already going to
be spent by the Federal Government in housing to give people an
opportunity and have that full--not just the in-residence
service but another piece of the bigger wraparound service. But
it was stated to me that the biggest loss of people in recovery
is when they get the sober-living part.
So I appreciate your leadership on this, Congressman Barr.
I certainly appreciate the Chairman coming to our wonderful
Commonwealth, and I appreciate having the Governor here as
well. We got to serve together in Frankfurt when I was in the
legislature, and I am pleased to have you here and all of our
witnesses. So thank you, and I yield back.
Mr. Duffy. The gentleman yields back.
Again, I want to now welcome our witnesses. Our first
witness, who actually is the Governor who I didn't recognize in
my opening statement, Governor Fletcher, former Governor of
Kentucky and the Founder of Recovery Kentucky, welcome; our
second witness, Mr. David Boggs, President and CEO of
Opportunity for Work and Learning, also known as OWL; Mr. King,
our third witness, Executive Director and CEO of the Kentucky
Housing Corporation; Ms. Minton, Executive Director of the
Chrysalis House. Our fifth witness is Mr. Tim Robinson, Founder
and CEO of Addiction Recovery Care. Our sixth witness today is
Mr. Jerod Thomas, President and CEO of Shepherd's House. And
our final witness, but not least, is Dr. Sharon Walsh, Director
of the Center on Drug and Alcohol Research and Professor of
Behavioral Science and Psychiatry at the University of
Kentucky.
To all of you, welcome. Thank you for giving us your time
today. Again, this is important for us to get out of the bubble
of Washington, D.C., and come and take the testimony and
insights from those around the country who are on the frontline
dealing with these issues so we can take that insight back to
Washington to our colleagues.
The witnesses in a moment will be recognized for 5 minutes
to give an oral presentation of their written testimony.
Without objection, the witnesses' written statements will be
made part of the record following their oral remarks. Once the
witnesses have finished presenting their testimony, each Member
of the subcommittee will have a length of time within which to
ask the panel questions.
With that, Governor Fletcher, you are now recognized for 5
minutes.
STATEMENT OF HON. ERNIE FLETCHER
Mr. Fletcher. Chairman Duffy and other Members, Congressmen
Barr and Guthrie, thank you for this opportunity. And, Chairman
Duffy, welcome to Kentucky. I hope you do get to spend some
time and see what a wonderful State it is.
You have my testimony there, but let me just speak a little
bit from the heart. It is obviously a public health crisis. It
is a very challenging, complex crisis that we face. There is
not a simple solution, as has already been noted. And even with
the reports yesterday, every 7 minutes someone dies of
overdose, if we look at combining that with alcohol where every
6-1/2 minutes someone dies from alcohol abuse and its
consequences, and then if you combine that with about every 12
minutes someone dies from suicide, many of those suicides are
related to substance abuse disorder, you can see the complexity
of the problem of addiction that plagues this Nation.
Going back 10 years, we looked at models that worked in a
residential program out of The Healing Place in Louisville and
the Hope Center in Lexington, Kentucky. It is a residential
program where folks come in. We use a peer-support 12-step
model, and we had fairly good efficacy from that. I will say
that it is not for everyone, and we think we can improve on
that model.
But we took that model, we developed some very creative
funding. This was done by an individual by the name of Don
Ball. Don Ball is a builder/philanthropist here who had worked
with the Hope Center. I appointed him as Chair of Housing
Corporation, and he brought together several funding streams to
fund the expansion of centers modeled after the Hope Center.
Now, we have 18 of those. We have 2,100 beds at any one time.
University of Kentucky's Drug and Alcohol Research Center does
our surveys. Eighty-four percent are drug-free at 1 year.
Seventy-five percent are gainfully employed at the end of that
program. Recidivism rate, as the criminal justice system, is
very low, and so it is an effective program.
I will give you the caveat that at the beginning, 30
percent of folks, as a voluntary program, walk away and it is
not for them, and I think that would address the need for
medication-assisted treatment and more of a comprehensive
approach than just one-size-fits-all.
The bottom line is we have 18 centers here that are working
very effectively and transforming lives, and we are taking and
expanding that nationally. As you look at what we face
expanding that nationally, let's look at the funding streams.
We use low-income housing tax credits, we use some other
Federal home-loan moneys for the capital construction of these
facilities. That runs about $5-6 million.
We use Section 8 vouchers, food stamps, per diems from
corrections because up to 70 percent of our residents come out
of corrections, whether it is parole, probation, or diversion
from drug courts. And these are nonviolent offenders. It is a
good investment for them. They pay a per diem, and as I
mentioned, the recidivism rate is very, very low for these
individuals, so it works for the benefit of the recipient, as
well as for the Department of Corrections in saving money
substantially.
As we are taking this nationally, though, what we find is
that Section 8 housing is a little more challenging to get in
the operational side of things, and for that reason, we are
very supportive of the THRIVE Act, Congressman Barr, that you
have put forward, because it sets aside some of these moneys
for this type of program. And there are two advantages of that.
One, we think it recognizes that these programs, when they are
evidence-based or have some outcomes that show that they work,
they help make sure that we are not funding programs that don't
work. Unfortunately, in the recovery industry, let's face it;
there are some scams out there and a lot of families spend a
lot of money on recovery only to find that their loved one
comes back and is not truly recovered or treated. Folks end up
financially broke trying to get their loved ones the treatment
they need. So this Act, making a stipulation, focuses on making
sure that only quality programs are funded. So, thank you,
Congressman, for that insight.
As you look at some of our other funding, we are working
with the Department of Corrections. We have worked with
Secretary Ben Carson. He has been here to Kentucky. We have met
with him here, and Congressman Barr was in that meeting. We
also met with him at his office, and they are very supportive
looking at how can we work with HUD to make sure that we expand
these programs and make it available. We are working in other
States now, and Georgia is one of our first States that we are
working. We want to expand them in Kentucky because we still
have a need here. We are also working with other programs. Tim
Robinson is here, and we are glad to collaborate with other
programs to make sure that we provide as many people as
possible with this type of recovery.
The other thing that I want to say about the congressional
funding, you have nearly $6 billion that is coming, funding to
fight this opioid crisis, much of that is going to medication-
assisted treatment because it is the gold standard of
treatment. Dr. Walsh will address a lot of this.
In our recovery program, what we find--and we are expanding
because we see that it doesn't fit everyone. We have 30 percent
at the beginning that may drop out, and they would likely, very
likely benefit from MAT, or medication-assisted treatment.
We also have some folks that end up relapsing as they
leave, so a program that combines the best of these I think is
something that Congress needs to make sure that, as you are
looking at the funding, as you--final passage of these bills,
that you recognize this full continuum of care.
These vouchers that are set aside in Section 8, I think are
very important. Congressman Guthrie, your bill, the
Comprehensive Opioid Recovery Centers Act, I think is important
and recognizes the issue we have talked about, so I appreciate
and hope we can pass that.
I have a few specific recommendations, and I will close
with that. One, I would like to recommend obviously passage of
the THRIVE Act through the Senate as it becomes a part of this
larger package to fight this public health crisis. There is
always a challenging--and I think some of the criticism is
that, well, you may be taking some money from some other folks
that need it. Let me say there is no greater need than these
folks that are held captive by addiction. If you look at the
sequelae of their life, it is abysmal without some kind of
treatment, so there is no greater need.
I would like you to consider to take some of the $6 billion
that you are looking at and making sure that it might be
allocated toward more of these because we have a proven model.
It is not the only model, but we have a proven model that we
can take nationally, collaborating with MAT and collaborating
with other centers to expand the treatment, and so let me ask
you to take a look at that.
I would like to--part of our funding is Community
Development Block Grants. That is always threatened. The
President's budget usually cuts those. And when I was in
Congress, and you all--usually, we have to put them back. But I
would like you to take a look at a similar program.
You will find that part of what we are doing--and according
to the CAREER Act is we want to be able to provide the skills
that an individual needs in order to enter the workforce. What
is important in recovery is having meaning and purpose, and a
good job and a purpose in life with a skill is extremely
important in preventing relapse. And so I think that is
important as you look going forward at where you are putting
the funding. And Community Development Block Grants, this is
community development, so I would like you to take a look at
that and see if there is not some other way that you can make
that funding a little more assured and sustainable because,
right now, our funding for these programs is sustainable, and
that is what makes them strong.
Last, I will recommend--and this is just probably out of
nowhere and you all don't have the jurisdiction except for--or
maybe Guthrie in that second-best committee. But this is a
public health crisis. We have the EOC, Emergency Operations
Center, activated at the CDC right now for polio. It is
affecting three countries right now, and they are: Pakistan,
Congo, and I think Nigeria. It is not activated for this. I
think it is a perfect center. This is an epidemiological
problem. It is a public health problem, and I just encourage
you to take a look at activating the Emergency Operations
Center out of CDC for this. It will allow them to bring a lot
of the silos that we have with NIDA (National Institute on Drug
Abuse), NIH (National Institute of Health), SAMHSA (Substance
Abuse and Mental Health Services Administration), other parts
of HHS together.
So let me close with that and say thank you for this
opportunity.
[The prepared statement of Mr. Fletcher can be found on
page 40 of the Appendix.]
Mr. Duffy. Thank you, Governor Fletcher.
Mr. Boggs, you are now recognized for 5 minutes.
STATEMENT OF DAVID BOGGS
Mr. Boggs. Thank you very much. Good morning, Chairman
Duffy, Congressman Barr and Congressman Guthrie, and other
guests. It is an honor to address this committee this morning
in regards to the epidemic of opioid addiction in our Nation
and the serious housing challenges that this population faces.
Since housing is a vital step in the recovery and reentry
process, the Acts that we have already talked about that have
been introduced by Congressman Guthrie and Congressman Barr,
THRIVE and CAREER Act and others, will have a major impact on
abolishing this crisis that we are facing across our Nation.
Considering that this epidemic touches every family in our
Nation, something needs to be done in the seriousness of it.
Just this morning on our national news it was announced that
the national lifespan for individuals has dropped because of a
leading factor of drugs, and that is tragic for us to reach
that point in our Nation today.
I would like to share with you the role of Opportunity for
Work and Learning and how it plays with the topic at hand and
some views of how the Federal Government, through our
organization, can use existing housing and our community
development program to complement community efforts to treat
individuals experiencing the opioid epidemic. OWL provides key
elements in the transitional path to self-sufficiency through
job training and employment services.
Housing and employment definitely go hand-in-hand, so it is
difficult to successfully maintain one without the other. And
yet, too often, our offender reentry population, whom we work
with a great deal, have at least one of these or both of these
once they are released from incarceration. Consistent housing
cannot be obtained without employment that will provide enough
income to meet the demands of either renting or owning in the
long term. Many of these individuals lose their employment due
to the challenges faced through inconsistent living through a
term that we often hear called ``couch surfing,'' and that is
very real for this population that we all serve, along with the
homelessness.
Individuals come to OWL from many different paths. Some of
them are coming from incarceration, some of them are coming
from short- or long-term recovery programs, and there are a lot
of people entering our program that are still struggling with
the opioid addiction but yet trying to maintain employment. The
struggle is overwhelming and often leads to more serious
consequences for these.
The mission of OWL is, simply, OWL partners with
communities to help individuals overcome barriers to achieve
personal and professional growth. We have been doing that since
1961. But in our Nation there is--annually, 600,000 people are
being released every year from incarceration, and the number of
people at risk of falling back into this lifestyle that led
them there in the first place continues to climb because of
inadequate housing or the lack of employment. In addition to
the criminal record preventing these individuals from finding
jobs, statistics show that ex-offenders far too often have
limited education and work experience and therefore do not have
the skills necessary to enter today's workforce with the
adequate skills.
The Lexington Manufacturing Center (LMC), which is a wholly
owned subsidiary of OWL, is an on-site advanced manufacturing
center that provides training in the essential skills that are
so desperately needed and demanded by today's employers in
every job sector. LMC employees earn more than minimum wage,
and while they are there, they get benefits, the opportunity
for bonuses, and they have the opportunity to work for other
companies and earn a greater income because we are just a
training facility in many aspects.
The various training programs that we provide such as our
forklift certification, our manufacturing certification and
material handling, third-party inspection, kitting, assembly,
woodworking, all of these offer new opportunities for these
individuals to reenter into the workplace and become
successful. The programs that OWL and LMC have in place have
proven to be successful as a research-based program in the path
to self-sufficiency and attainment of stable housing and
employment.
OWL has maintained a strong partnership with the Kentucky
Office of Vocational Rehabilitation since its beginning in
1961. Over these years, our organization has successfully
provided services for 23,000 individuals in central Kentucky.
Through OWL's services and programs in Fiscal Year 2018 alone,
over 74 individuals found full-time employment, not temp
service or not part-time but full-time employment with job
benefits. Yet while this is successful numbers, over 60 percent
of them had some type of opioid and substance abuse while they
entered our program.
OWL completely adheres to the work being done with WIOA,
the Work Innovation Opportunity Act, and we support all the
mandates of community rehabilitation programs required in that
through our youth grant, out-of-school youth grant.
Paul, a good example of our work, came to OWL as a result
of an ongoing opioid addiction that cost him his home, his
family, and also some incarceration time. Fortunately, after a
period of time, Paul became involved at a drug court diversion
program, and they opened their doors to him instead of the
long-term incarceration. Today, he is reunited with his family.
He now has adequate funding and support through his job at OWL,
and now he has homeownership. This is what we are all striving
to reach together through this funding mechanism.
James came to us after serving 24 years in our Federal and
State judiciary systems and still struggled with opioid
addiction time after time. But thanks to our partnership with
community housing agencies that we work with within our
community, many of them represented here today, James was able
to begin his pathway to a new life. Today, he has been fully
employed at OWL for over 5 years and lives independently.
Paul and James are just two examples of individuals who
have struggled because of the impact of the opioid addiction on
their lives. Sadly, they are not alone, as we have already
heard here today. There is an overwhelming need for housing and
employment services for others trying to escape the opioid
crisis in their life. Funding must be accessible--it is not an
option--it must be accessible for research-based programs like
OWL and others represented here today and have a proven track
record of employment training, job placement, and housing.
Programs that can easily be replicated and expanded upon in our
individual communities must be provided oversight and guidance
to establish consistency in collaboration among agencies to
maximize resources and human capital.
Yes, we applaud the work being done by this committee and
the leadership of our local Congressmen in Kentucky through
bills that have already been sponsored and passed, but the
battle against the housing and opioid crisis is not just a
Kentucky epidemic but a national pandemic that has no borders.
Thank you again for this opportunity to share with you this
morning.
[The prepared statement of Mr. Boggs can be found on page
36 of the Appendix.]
Mr. Duffy. Thank you, Mr. Boggs. And it has no borders; you
are right.
Mr. King, you are recognized for 5 minutes if we can figure
out the microphone situation.
STATEMENT OF EDWIN KING
Mr. King. Hopefully, you can hear me. Chairman Duffy,
Congressman Barr, Congressman Guthrie, thank you all for
holding this hearing. As you said, I am the Executive Director
of the Kentucky Housing Corporation, the Commonwealth's housing
finance agency. And on behalf of KHC's board of directors and
staff, again, we thank you for conducting this hearing and
affording me the opportunity to speak with you today.
I want to thank Congressman Barr and Congressman Guthrie
publicly for bringing attention to the problem of the opioid
addiction in the Sixth and the Second Districts. Thank you all.
Congressman Barr, the passage of your bill, the Transitional
Housing for Recovery in Viable Environments, the THRIVE Act,
demonstrates your commitment to housing solutions for those on
the road to recovery, so thank you for that.
It is my pleasure to share information about Kentucky's
accomplishments through leveraging housing resources to help
our citizens on the path of recovery from substance use
disorders. There are multiple effective recovery strategies
depending on the personal circumstances of those that are
caught in the grip of addiction, as Governor Fletcher has
alluded to. Access to stable housing is a basic human need and
one of the primary social indicators of public health.
One of the most successful recovery strategies that we have
seen here in Kentucky is of course the Recovery Kentucky model.
In 2004, the late Don Ball took the helm as the Chair of
Kentucky Housing Corporation under Governor Fletcher's
administration. Mr. Ball brought with him a personal
commitment, a strong will, and a solid plan to establish a
network of recovery centers across Kentucky. Because of Mr.
Ball's vision, Kentucky now has 14 recovery centers that have
helped thousands of our residents start a new life of recovery
from addictive substances. These 14 centers are in addition to
the other four centers, two in Louisville--The Healing Place--
and then the two Hope Centers here in Lexington. Today, these
18 recovery centers serve and help over 2,000 men and women
daily.
The Recovery Kentucky Centers follow a peer-to-peer
education and self-help model to provide sustained addiction
recovery services. Peer mentors model behaviors and spiritual
principles that focus on providing life skills to residents by
following the spiritual principles of the 12 steps of
Alcoholics Anonymous. Information from U.K.'s Center for Drug
and Alcohol Research points to the significant successes that
we have seen here in Kentucky, and I mention those in my
written testimony.
Additionally, the program has saved taxpayer dollars
through avoided cost to society or costs that would have been
expected based on the rates of drug and alcohol use, and that
can't be understated. For every dollar we spend on these
recovery centers, we save $2.60.
Recovery Kentucky would not have been possible without
housing program dollars appropriated by Congress and
administered by the Kentucky Housing Corporation (KHC). The
recovery centers rely on a complex array of Federal funds for
construction and operation, including the following: The bricks
and mortar are built with the low-income tax credits and also
HOME dollars and some affordable housing trust fund dollars
that we have here in the State of Kentucky. There is also CDBG
funds that are used, as well as Section 8 Housing Choice
Vouchers for rent subsidies for the residents at these
facilities, and also, as has been mentioned, food stamps.
It has become increasingly difficult to develop more of
these recovery centers for two primary reasons. The first is of
course less funding in Federal housing programs, but the second
I really want to draw attention to, and that is red tape that
surrounds certain Federal programs. For example, KHC has
experienced significant challenges recruiting landlords to
participate in the Section 8 Housing Choice Voucher tenant-
based program, with many citing programmatic red tape as an
obstacle. Additionally, Federal statutes restrict the amount of
tenant-based rental assistance that may be used for a specific
property to 20 percent of a public housing authority's housing
choice vouchers. One useful reform would be to raise that 20
percent cap and allow public housing authorities like KHC to
project-base more housing choice vouchers to meet our specific
needs here in the Commonwealth.
I sit on the board of directors of the National Council of
State Housing Agencies, so I have the opportunity to speak with
many of my colleagues across the country, including my
distinguished colleague in Wisconsin--Mr. Winston does great
work in Wisconsin--and I can tell you that, nationally, this
would be accepted on a bipartisan basis. It is an option that
allows housing choice vouchers to be project-based, but each
State doesn't necessarily have to do that. So it would be a
significant reform to potentially look at building more
recovery-type models, regardless of treatment methods.
I will conclude my remarks with these key statements:
Recovery Kentucky is a housing-based model that has produced
remarkable outcomes and has proven to be highly cost-effective;
housing is a key component of successful recovery programs and
essential for long-term recovery; and greater flexibility with
Federal housing program regulations will provide States with
more control of the resources needed to achieve the goals of
the President's Commission on Combating Drug Addiction and the
Opioid Crisis.
Thank you for taking on this difficult but important work
to help ensure access to effective recovery programs. Kentucky
Housing Corporation led the way more than a decade ago, and we
stand ready as a dedicated partner in the continuing effort.
Thank you.
[The prepared statement of Mr. King can be found on page 49
of the Appendix.]
Mr. Duffy. Thank you, Mr. King.
The Chair now recognizes Ms. Minton for 5 minutes.
STATEMENT OF LISA MINTON
Ms. Minton. Thank you, Chairman Duffy, Congressman Barr,
and Congressman Guthrie. I am the Executive Director of
Chrysalis House, and I am very pleased to be with you today.
And I would be remiss if I did not introduce our wonderful
board president, Lindy Karns, who is also here today. That just
shows what a wonderful program Chrysalis House is. Our board,
our staff, our community partners, and everybody that we work
with, we come together to do the best that we can for the women
and children that we serve.
And we have been saving lives for over 40 years. We are
Kentucky's oldest and largest licensed substance abuse
treatment program for women. And the chrysalis is the protected
stage just before the beautiful butterfly emerges, and that is
what we want for the 200 women and babies that we serve every
year.
As reported in the Herald Leader this past weekend, the CDC
report recently stated that Kentucky had one of the highest
rates in the Nation of pregnant women using opioids, and that
is another example of the State's struggle with abuse of pain-
killing drugs.
At Chrysalis House, we prioritize pregnant and parenting
women, and we are one of the few programs in the Nation that
allow women to bring their babies with them into treatment. We
believe the opportunity for our clients to be with their babies
and young children is a powerful incentive for recovery.
A brief snapshot of the women that we are currently
serving: Their average age is 26 to 30, 41 percent are
pregnant, 61 percent report their primary substance abuse is
heroin or other opioid, 85 percent have had one or more prior
treatment episodes, 98 percent are unemployed, and 60 percent
meet the homeless criteria for transitional housing. This
population needs additional recovery supports. Housing and
employment are imperative to long-term sobriety.
Chrysalis House received our first HUD Transitional Housing
Grant in 1990, and we've received HUD permanent housing funding
for over 20 years. In 2016, our $200,000 grant was cut by our
continuum of care due to the change in HUD's vision for moving
forward and serving the chronically homeless and housing first,
which we agree with, but we do think that there is room for
transitional housing because our women and their children,
after they go through 3-to-6 months of treatment at Chrysalis
House, need sober, stable living in order to achieve long-term
sobriety.
The next year, we lost our $93,000 scattered-site apartment
funding and our $60,000 permanent-housing bonus apartments, so
we have gone from $360,000 a year in HUD funding to zero. And
so this shift in HUD's view, I can see that, but we also think
that there is room for transitional housing. And so we look
forward to working with you all on the CAREER Act and the
THRIVE Act and any other ways to help the women and children
that we serve at Chrysalis House.
So I thank you for allowing me to speak today, and I am
glad to take any questions.
[The prepared statement of Ms. Minton can be found on page
52 of the Appendix.]
Mr. Duffy. Thank you, Ms. Minton.
Mr. Robinson, you are recognized for 5 minutes.
STATEMENT OF TIM ROBINSON
Mr. Robinson. Good morning, Chairman Duffy, Congressman
Guthrie, Congressman Barr. My name is Tim Robinson. I am the
CEO of Addiction Recovery Care. More people died from overdoses
than car accidents last year, making addiction a national
public health crisis that is taking too many lives and
threatening our economic security, as employers struggle to
find and retain employees. Last year, our Kentucky Chamber of
Commerce CEO wrote in an op-editorial and he called addiction
the number one economic concern in our State.
Everyone is looking for a silver bullet to address the
addiction crisis. The reality is there isn't a silver bullet.
Addiction recovery requires a whole-person approach, which
starts with intervening with treatment, investing in someone's
economic future by providing access to transitional housing,
vocational rehabilitation, workforce development, and inspiring
them from day one that there is hope to go from their crisis to
a career.
I am thankful for the opportunity to speak to you because
recovery is personal to me. I started drinking in my first year
of law school at the University of Kentucky to cope with my mom
passing away during finals. For the next 8 years, I almost
drank myself to death. Eleven years ago while I was a
prosecuting attorney in Lawrence County, Kentucky, a court
bailiff, who was a recovering alcoholic and pastor, led me to a
spiritual awakening at my desk. He became my sponsor and my
pastor. And addiction recovery is personal to me because I am a
survivor.
Two years later in 2008, I resigned as prosecutor and in
2010 opened a residential center for women in rural eastern
Kentucky. Today, we have 350 residential clients and 500
outpatient clients and centers across 12 counties in Kentucky.
Our experience has taught us that addiction is a disease that
devastates all aspects of a person's life, impacting someone's
mind, their body, their spirit, and their purpose. And we have
been determined to treat addiction holistically, medically,
clinically, spiritually, and vocationally.
Our centers are led by an addictionologist and are
nationally accredited. We have developed a spirituality program
that inspires hope and offers redemption. Much like hospice
centers, we employ chaplains who work alongside our clinical
staff, and though we consider the spiritual aspect of our
centers to be the heart of our success, our spirituality
program does not replace medical and evidence-based clinical
practices. It is in addition to them and makes our care more
comprehensive.
Treating the whole person has led to great success. One of
our payers recently reported to us that our centers reduced
their members' healthcare costs by 33 percent during the 6
months after they completed our program.
We created an internship program with the promise that
everyone who completes the program would be guaranteed a job.
Today, 190 of our 380 employees are in recovery, and of those
380 employees, 130 are graduates of our programs.
We are a State-certified peer-support training program. A
peer-support specialist is a Medicaid-billable professional who
has 1 year of sobriety and completes a certification program.
We partnered with a workforce board, Eastern Kentucky CEP,
and with Sullivan University to expand our internship into a 6-
month career academy. Our graduates earn State certification
and college credit. In just 1 year, a person in addiction can
go from an IV heroin user to supporting themselves, literally
going from their crisis to a career.
To date, 41 of our 46--or 85 percent--of our academy
graduates are clean and sober, working full-time, paying taxes,
and transitioning off public assistance. Some of the graduates
have been promoted to management, and others are continuing
their education for careers such as counseling. Prior to the
academy, 40 percent of our clients chose to continue treatment
beyond detox in residential care. After giving folks an
opportunity to go from crisis to career, 70 percent of our
clients now choose to continue treatment, doubling treatment
motivation.
Vocational education that leads to a meaningful career that
provides the dignity of work gives those reentering the
workforce the confidence necessary to establish career goals
and plan for their future. Because of this success, we are
adding other programs such as an auto mechanics academy.
Kentucky may be leading the Nation when it comes to our
drug crisis, but Kentucky is also leading the way in access to
treatment because of the national leader on this issue,
Congressman Hal Rogers, who has been working on this issue for
more than a decade, and the efforts of our Governor Matt Bevin,
who is making Kentucky a second-chance State.
But the two biggest challenges preventing us from taking
more people from crisis to career is a lack of funding for
workforce development and transitional housing. That is why I
am so excited about Congressman Andy Barr's bill, the THRIVE
Act, and our Senate Majority Leader Mitch McConnell's CAREER
Act, and that Congressman Guthrie has convened joint committee
hearings on the issue of helping people in addiction who are in
recovery get the workforce development they need. And these two
historic pieces of legislation have the potential to transform
the national effort to combat the drug epidemic.
In closing, the hope of America is not merely surviving.
The hope of America is an opportunity to flourish. That is what
our brothers and sisters in addiction need. They need an
opportunity, an opportunity for treatment, transitional
housing, and workforce development that leads to a meaningful
career path. And when the opportunity is given, I have seen not
just survive but thrive. Our current human capital and labor
shortage can be solved at the same time we combat the drug
epidemic as we take those struggling with addiction from their
crisis to a career.
[The prepared statement of Mr. Robinson can be found on
page 55 of the Appendix.]
Mr. Duffy. Thank you, Mr. Robinson.
Mr. Thomas, you are recognized for 5 minutes.
STATEMENT OF JEROD THOMAS
Mr. Thomas. First, let me thank you for including me today.
It really is an honor. My name is Jerod Thomas. I am the
President and CEO of the Shepherd's House. The Shepherd's House
is a nonprofit, long-term transitional living home for men 18
years and older that have a drug or alcohol addiction. We have
been providing this treatment for 29 years, since 1989. We are
one of the few transitional-living houses that offer recovery
care for our clients 24/7. We offer a lot more than just a roof
over your head.
Our long-term residential recovery program is very similar
to the model of the THRIVE Act. We are a therapeutic community,
and our primary focus is on helping these men acquire daily
living skills. In our day, we offer individual counseling,
group counseling, conflict resolution, anger management
classes, parenting classes, education programs, money
management classes, and art therapy. We also feature a one-of-
a-kind jobs program in which 90 percent of our clients get a
job within 3 weeks of entering our transitional-living house.
Employment is mandatory at the Shepherd's House. To prepare
our clients for employment, we provide professional assistance
with resume building, interview skills training, personal
presentation, employment goalsetting, and teambuilding. We
partner with DVA Kitchen, Employment Solutions, Vocational
Rehab of Lexington, and OWL.
The Shepherd's House has never received any Federal grant
money for any of our programs, but we have received grant money
from Federal Home Loan Bank and Kentucky Housing Corporation in
the form of brick-and-mortar grants, which require income and
special-needs verifications, which are similar to the Section 8
rental assistance voucher program, so we are very familiar with
the process.
Under our transitional housing model, clients pay a portion
of their income as rent. That does not cover my utilities, my
food, and my professional therapies cost. The bulk of our
expenses are funded by the donations the Shepherd's House
receives, so basically what I am telling you all today is the
good people of Lexington, Kentucky, keep my doors open. Because
we have had so much success, the donations have increased. I
believe the THRIVE Act will have similar results. The financial
support the THRIVE Act could provide would ensure our continued
success, as well as allowing us to serve more people.
And I really wanted you guys to hear me today, but I
thought it was more important that you feel me today, so I
brought Donna Schuler with me today. Donna, could you stand up?
Thank you, Donna.
Donna is a great friend of mine and a wonderful mother. Her
28-year-old son Luke Andrew Schuler died of a drug overdose on
December 9, 2016. Luke was on my waiting list at the Shepherd's
House. He was 2 weeks away from his bed date. We live with that
every day, knowing a life was lost because we didn't have room.
There are perhaps countless others who are waiting that we
don't know about. Luke's mother Donna, in spite of her
unimaginable grief, rose to the challenge and has worked
tirelessly to get contributions to grow the Shepherd's House so
that no other parents have to bury their son because a bed
wasn't available.
The Shepherd's House currently has a 6-month waiting list.
The funding the THRIVE model facilities will receive would
allow us to expand our current bed capacity and offer more
services to more individuals. The housing cost burden will be
significantly reduced, and these precious funds will be freed
up to provide more services and more beds.
We currently follow all the Section 8 housing rules but
with more restrictions and services for the client. Like
Section 8, we require our clients to stay drug-, alcohol-, and
crime-free, but unlike Section 8, we provide the programs and
support to help them do so. We provide a 24-hour-a-day, 7-day-
a-week therapeutic community that gives you access to the daily
living skills necessary to stay sober and participate in the
game of life. Our focus is on the whole person. Our aim is to
meet all the client's needs while they are in our safe and
drug-free environment. The THRIVE-based model includes programs
like the Shepherd's House that have proven results of long-term
sobriety. Most of our clients are either income-eligible for
Section 8 or qualify as homeless, so the reallocation of these
vouchers still meets the letter and spirit of Section 8.
In preparing to give testimony today, I have looked at the
support offered by Section 8 vouchers, and I am excited that we
may be able to use those funds for people who want to live
sober, but the Section 8 voucher in and of itself is not the
end game. There are more pieces to this puzzle of life than the
housing issue. The THRIVE Act takes the intent of Section 8 to
provide safe and stable housing and partners that with the very
best treatment model we know of today. The union of these three
things--a treatment model with daily living skills
incorporated, job placement and education to secure a financial
future, and stable and adequate housing--that is the end game.
Through those relationships and funds, the THRIVE Act will give
drug addicts and alcoholics tools for change and solutions for
life.
Let me leave you with the sobering facts we live with here
in Kentucky. By the end of the day today, five more Kentuckians
will have died of a drug overdose. That means five more sets of
parents will bury kids, and five more kids will lose their
parents. Kentucky is always in the top five in overdose death.
At the end of our day today, let's use the THRIVE Act and the
CAREER pilot program in Kentucky to save those five lives.
Thank you.
[The prepared statement of Mr. Thomas can be found on page
59 of the Appendix.]
Mr. Duffy. Thank you, Mr. Thomas. And, Donna, thank you for
being here today, and we are sorry for the loss of your son
Luke. Thank you.
Dr. Walsh, you are recognized for 5 minutes.
STATEMENT OF DR. SHARON L. WALSH
Dr. Walsh. Thank you. Chairman Duffy and distinguished
Members of the committee, thank you for the opportunity to
appear today to discuss the role of Federal housing and
community-development programs to support opioid and substance
use disorder treatment and recovery. I want to thank
Congressman Andy Barr from Kentucky's Sixth congressional
District for inviting the committee to Lexington--I wish that
the weather was better for you--to discuss the Nation's opioid
crisis and how Kentucky leaders are responding.
My name is Sharon Walsh, and I am the Director of the
Center on Drug and Alcohol Research at the University of
Kentucky, and for the past 25 years, I have been engaged in
conducting research on opioid misuse, dependence, its medical
complications, best practices, and the development of novel
treatments for opioid use disorder. I have been fortunate to
have had funding throughout my career from the National
Institute on Drug Abuse, along with other sources, including
SAMHSA and the FDA (U.S. Food and Drug Administration). I am
here today representing the University of Kentucky.
The University of Kentucky has launched many initiatives to
increase access to care and accelerate the discovery of novel
approaches to address the opioid crisis in the Commonwealth and
the Nation. I will highlight only a few with my limited time
today.
The University of Kentucky Hospital emergency rooms see
approximately 1,000 non-fatal opioid overdoses in a given year
with approximately 50-plus cases of fatal overdoses. This does
not include those patients who present with significant and
life-threatening medical complications from injecting drug use
behavior who present virtually every day, nor does it include
all of those individuals who never make it to the emergency
department. Historically, emergency departments in our region
would treat the presenting problem and return the patient to
the street without attempting referral or linking patients to
care for their opioid addiction.
With the support from the CURES funds, through SAMHSA and
the State of Kentucky and the Cabinet for Health and Family
Services, a new service has been developed to address this
critical gap in care. The First Bridge Clinic is a new
initiative that allows our emergency departments to directly
refer individuals at high risk for fatal overdose and link them
to care. Patients can quickly begin receiving evidence-based
care, including medication-assisted treatment and start on the
path to remission and recovery. However, these patients often
have many other psychosocial problems that are barriers to
treatment success and retention in treatment. For example, a
criminal record is a barrier to employment, and unemployment is
a barrier to housing. Linking all patients to the requisite
supportive services is essential for long-term recovery,
especially housing when needed.
Another U.K. program that is having a profound impact that
Congressman Barr mentioned earlier is PATHWAYS, a program
designed specifically for the care of pregnant women suffering
from opioid use disorder. PATHWAYS opened in 2014 and has
treated more than 200 women and their newborns. Women are able
to receive evidence-based care, medication-assisted treatment,
and good prenatal care. The large majority of women achieve
abstinence and deliver their babies with no illicit opioids in
their systems. And the incidence of babies suffering from
neonatal abstinence withdrawal has been reduced by more than
half. U.K. just opened a specialized NACU unit that is an
eight-bed unit that is specifically for the care of babies born
with drug exposure. Our postpartum program for the support of
new mothers, Beyond Birth, is also expanding with the help of
Medicaid assistance.
Young mothers with new babies may be the most vulnerable of
all the patients that we see. This is a high-risk group that
may require housing services, housing that allows infants and
other children in order to promote retention in care and
sustained remission.
In Kentucky, there was little to no opioid abuse before the
current prescription opioid epidemic began. There was no
heroine historically. Most existing treatment facilities and
housing services were not designed to address the unique issues
associated with opioid use disorder that set it apart from
other substance use disorders. This is a very unforgiving
disorder. A single lapse or relapse can lead to the immediate
death of a person who is striving to sustain their recovery. A
single mistake ends a life.
Federal agencies, including the FDA, SAMHSA, and NIH, all
agree that the most effective approach to the treatment of
opioid use disorder is pharmacotherapy, also known as
medication-assisted treatment, including buprenorphine,
methadone, and naltrexone, and all are calling for its expanded
use. These medications effectively reduce drug use, improve
health, reduce the transmission of infectious disease, and,
most importantly, protect individuals from fatal overdose.
It is commonly recommended that part of the path of
recovery is to change the people, places, and things that are
associated with one's past drug-using lifestyle. This may
involve moving into residential care or recovery housing.
Unfortunately, many of these facilities prohibit or exclude
patients who are receiving all or specific FDA-approved
medications under the supervision of a trained physician.
Providing healthy- and safe-living housing environments for all
patients seeking recovery is essential, and programs receiving
government support should not only allow but should also
promote the use of all evidence-based practices in treatment
and housing programs.
The University of Kentucky looks forward to working with
Congress and other leaders to leverage the expertise and
resources of the Federal Government in a strategic and
coordinated manner. As a historic land-grant and flagship
research university, the University of Kentucky was founded for
the people of Kentucky 150 years ago. That is why we are here,
to keep a deep and abiding promise of better tomorrows for our
community, our region, and the Commonwealth.
I sincerely appreciate the opportunity to present testimony
before the subcommittee, and I am happy to address any
questions. Thank you.
[The prepared statement of Dr. Walsh can be found on page
64 of the Appendix.]
Mr. Duffy. Thank you, Dr. Walsh. I want to thank our panel
for their insights and their testimony. The Chair now
recognizes himself for roughly 5 minutes for questioning.
First, I neglected to mention how grateful I am for the
warm welcome that you have given me in Kentucky, especially
after Wisconsin ended your undefeated season in 2015 in the
Final Four. Mr. Guthrie was at that game.
With that said, listen, this is a heart-ripping
conversation. I was a prosecutor for 10 years, and over 10
years ago in my small county we saw more deaths from opioids
than anything else in our community. And there was really no
national conversation or even a Statewide conversation at that
time, and so we put together a community taskforce. That is
what we do, right? We try to go, how do we help our other
community members when we see a crisis that burns? We don't
always look up the food chain; we look to ourselves to try to
address the problem.
And I was the prosecutor, so I had the D.A., I had the
judge, we had the school, law enforcement, the pharmacist,
everyone was getting involved, and one of the problems that we
had was--if we have any doctors in the room, I am sorry--but
the doctors were the ones where, again, they were the flow of
the OxyContin, which was our issue of opioids. They were the
flow-out, and we couldn't get their participation early on to
even deal with random pill counts, to do random testing. And
when someone comes in on a Friday afternoon and says that the
dog ate their Oxy and they want another 30-day supply and they
were getting it, this was insane stuff.
And so no wonder we have a crisis on our hands that was
made not by the drug dealers, but whether we want to talk about
pharmaceuticals or whether we want to talk about doctors and
hospitals, and it has absolutely ravaged all of our communities
across America.
In Wausau, Wisconsin, I did a roundtable with many of my
sheriffs and our attorney general, and what you see is how it
is even addressing our kids, parents that are doing heroin in
the car outside the drug house and the kids are in the back
seat in the carseats as the parents are strung out in the front
or what is happening inside homes of cereal being dumped on the
floor for kids to eat for a couple days as the parents are on a
drug binge.
And some of the sheriffs were talking about how some of
their deputies have started to drink more to cope with what
they are seeing in our community, so you have seen drug use
that translates even to some of our law enforcement deputies
starting to consume more alcohol to deal with the pain of what
they are seeing in their community with kids and with adults.
And there is no silver-bullet answer here I don't think, but
trying to find bright spots that can help our communities deal
with these issues is incredibly important.
Just to the panel, I don't know if you guys have this
scenario. Are you seeing more out-of-home placements for
children in your community because of this epidemic? Is that a
fair assessment, Governor?
Mr. Fletcher. Yes, we are involved with the group in
Georgia, Rome, Georgia, and up to 70 percent of foster home
placements are related to substance use disorder. And a lot of
the data across the country shows increase in foster care, and
we don't have near the adequate number of foster parents or
volunteers to accommodate that, so we are facing--one of the
consequences of opioid use disorder is going to be a tremendous
impact on the children going forward, and the NAS that Dr.
Walsh mentioned as well.
Mr. Duffy. And just for my smaller counties, we don't come
from a wealthy area in America or in Wisconsin. We have some
pretty poor counties. The counties don't have the resources to
actually fund the out-of-home placements, which you want money
to address addiction, but then you are spending money to
address the consequences of it with the out-of-home placement
for children, which a lot of our counties are struggling to go,
how do we deal with this? It is a financial problem; is that
fair to say, Governor?
Mr. Fletcher. Yes. One of the things that I think as we put
this in the context of other works being done with NIH and the
healing communities and NIDA is--and we are starting a project
in Rome, Georgia, where we are looking at a group that handles
foster care in addressing women. It is going to have to be a
community-wide program of having a community that addresses
these issues comprehensively, similar to what you started off
with, your effort with the taskforce on opioids in your
community.
But I do think the healing community and having part of
MAT, residential continuum of care that even addresses to
reduce the incidence or the need of foster care by addressing
these generally single moms early on or maybe both parents that
are under substance use, but getting them into recovery so that
you can reunify that family, which has historically been the
best impact on a child's well-being is reunification.
Mr. Duffy. Yes. Mr. King?
Mr. King. And what we are seeing in housing, we are really
focused on two populations: Seniors and children. And you are
seeing this spillover effect among youth and youth who are
aging out of foster care. We have dedicated our resources to
try to alleviate some of the issues with seniors, grandparents
housing, having to house or find the resources to house their
grandchildren.
Mr. Duffy. Yes.
Mr. King. I talk often about a holistic approach to
housing. When you are looking at the spillover of an increasing
population of youth and youth aging out of foster care, another
housing approach that we have introduced in Kentucky is the
Scholar House model, which helps single parents go to college
or technical school and receive a degree and become a
participating member of society. We are now over the next year
going to be introducing a Scholar House model for youth who
have aged out of foster care. But we are definitely seeing an
uptick in housing resources going specifically for seniors who
are caring for their grandchildren.
Mr. Duffy. Anyone else want to comment?
Ms. Minton. Well, I want to say that is one of the great
things about Chrysalis House is that we allow the babies and
children under 2 to live with their mothers while in treatment
and older children come and spend the night on the weekends.
Then the whole family reunites when they move into transitional
housing. And so we can help them all along the way. And here in
Kentucky the DCBS has a specialized team called START, which
stands for sobriety, treatment, and recovery teams. And
Chrysalis House works closely with the START team and with the
court system because a lot of times the judges would take the
children away, put them in out-of-home placement. But if the
woman is at Chrysalis House and is doing well and working on
her treatment plan, then they will allow the children to stay
with the mother, and so that does save our citizens a lot of
tax money.
Mr. Duffy. I don't know if anyone knows the answer to this
question. In regard to how we treat pain in America and if you
have been to the doctor--my wife and I, we have eight kids, so
at least every 2 years I have been to the doctor dealing with
pain in childbirth, not my pain but my wife's pain, and the
little smiley faces to the grimacing frown of the little face
in the doctor's office. And anyone have any comment about the
reimbursement method as it is tied to pain treatment with
people in hospitals? And if your assessment of pain is low and
doctors get a benefit for that, don't we start pushing drugs on
people when we should say, well, we don't want to actually push
some of these high-octane, highly addictive drugs on folks to
necessarily manage pain. Maybe a little bit of pain might be
beneficial instead of the possibility of getting hooked on a
very powerful drug. Am I off base, Dr. Walsh? Am I crazy up
here?
Dr. Walsh. You are not crazy. So I think the contingencies
are a little bit different, though, than what you have
described, so the contingencies aren't really about
reimbursement. Where the requirement came for physicians to
treat pain came out of JCAHO, the Joint Commission on
Accreditation of Hospitals, when they adopted the policy that
pain was going to be a vital sign--
Mr. Duffy. Right.
Dr. Walsh. And that initiative was I think unknowingly
pushed by groups that appeared to be legitimate scientific and
medical societies, but they were actually funded by the
pharmaceutical industry.
Mr. Duffy. That is right.
Dr. Walsh. So they were able to persuade the accreditation,
which every hospital needs to maintain in order to operate,
that pain was going to need to be treated well. And then the
other thing that drives it are patient satisfaction scores
because that is another thing that hospitals pay attention to
and that doctors are held accountable for.
Mr. Duffy. Have we changed that model now?
Dr. Walsh. So JCAHO certainly is reevaluating things, and
at the national level, there are a lot of physician
organizations that are really trying to do a better job with
coming up with guidelines. The CDC, I am certain, released new
pain treatment guidelines, but they are guidelines so they are
not mandatory. So we see some of the same bad practices
continuing both in hospital settings, outpatient settings,
dentist, mid-level providers. So while there is a lot of
popular news about this, you cannot possibly not know that this
is the biggest crisis that we are facing.
We still see a lot of bad prescribing practices. And just
as an example, in our State, the State Government changed the
law so that you could only have a 3-day prescription for a
Schedule II agent, and so what a responsible doctor would do
would give a 3-day prescription. What some who don't want to
get called on the weekends do instead, they will give a 3-day
prescription for 4 times as much as they would have prescribed
for a 3-day prescription so that there is more available so
that they are not getting patients calling up and saying that
they are in pain.
So I think that is really important when we are thinking
also about how we do both regulations around this, guidelines,
what is it that we are incentivizing because sometimes we are
missing the mark a little bit and--
Mr. Duffy. And we want to manage pain. We don't want people
not to be able to get medicine to manage their pain, but also
we don't want to push that pendulum too far over, which I think
you have mentioned, Dr. Walsh, that we have and it has to be
reevaluated. And frankly, we are not done with that process. It
is a little bit shocking based on the crisis that we are seeing
across America.
I have to end in one moment, but you all agree that housing
is a key component to recovery. We are all agreeing on that.
Good. We are on the same page. And just I thought that, Mr.
Boggs, you made an interesting point. When we are talking
about, you are dealing with those that have been convicted of
crimes who have served sentences, I don't know if you have the
same problem in Kentucky, but in Wisconsin, we don't have
enough workers to fill our jobs, and if we can move people,
whether it is from incarceration with skill sets into jobs or
from those who have drug abuse issues to skills sets to
meaningful jobs that give purpose in life, not only does it
help the individual, their family, but it helps our broader
economy because they are filling places in our workforce that
aren't being filled right now.
You talk about a--this is a holistic issue that we face as
a community and as a country. Mr. Thomas?
Mr. Thomas. That is a perfect example. What better place to
get your employees than living at our facility where they are
being drug-tested 3 days a week, and if you are positive, we
will not send a guy that is under the influence of drugs or
alcohol to work. We will simply call the employer and say he is
not going to be available today, but we have a guy that we can
send to you and you can start training today.
So we are actually doing that for you, so we take the cost
of the drug test and we monitor, so if you are in our
facilities or any of our facilities getting drug tests, you
have a safe and sober employee. That also saves money on the
other end almost like an employee assistance program would.
There are not as many workplace accidents when nobody is drunk
or high.
Mr. Duffy. That makes sense. I am going to pass it over in
a second to Mr. Barr, but again, we are talking about 10,000
vouchers out of 2.1, 2.2 million as a demonstration project to
see if this works. Again, this is how the government should
work to say let's take a little sliver and see if we can have a
real impact, and if it works, we can expand it, but it is only
10,000 vouchers, again, out of 2.2 million. I think that point
needs to be made also.
The fact that we are trying to address an opioid crisis is
different than--we have all dealt with alcohol and alcohol
abuse in many of our families. This is a new animal we are
trying to get our hands around and how we address addiction. I
know we are not talking about meth today, but that is a whole
other problem as well, and it is going to be all of us
partnering together. And I want to thank you all for the work
that you do to make Kentucky a healthier place, to help
families, individuals who are going through this incredibly
difficult time, helping them get to a place of health. And to
hear stories like Donna's, to make sure we don't have those
five people today, Mr. Thomas, go through what she had to go
through in her family, it is heartbreaking, and I appreciate
her strength and willingness to help other families and have
her and her son's story be told.
So with that, my time is expired, and I recognize the
gentleman from Kentucky, Mr. Barr, for as much time as he may
consume.
Mr. Barr. Thank you, Mr. Chairman. And again, thank you,
Mr. Chairman, for coming to Kentucky and listening to our
constituents about models of hope, about models of recovery.
Wisconsin has a crisis, Kentucky has a crisis, the whole
country is dealing with an opioid addiction crisis, an overdose
crisis. And the fact that you have spent the time and the
willingness to come to Kentucky and hear from people on the
frontlines who are offering solutions and taking our testimony
is something that I really appreciate.
Mr. Chairman, since you did mention the 2015 NCAA
tournament, I just respectfully remind the Chairman about 2014
and the 30-foot shot with 2 seconds left by Aaron Harrison that
knocked out your Badgers, so just for the record. I can say
that to the Chairman because--
Mr. Duffy. Duly noted.
Mr. Barr. --he is a good friend of mine.
On a more serious note, I do just want to make note of the
fact that it is altogether appropriate that this field hearing
is taking place in the United States District Courthouse. In my
conversations with members of the Federal judiciary, the
criminal docket here in the Eastern District is
disproportionately inundated with criminal cases that are
connected in some way or another to the opioid addiction
crisis.
Well, all of you have made very good points today, but let
me start my questions with Governor Fletcher. Thank you for
your testimony. Thank you for your leadership. Thank you for
your innovation with Mr. Ball a decade ago and for your
continued work in trying to take the Recovery Kentucky model
nationwide. It is a unique model. We know it works. My question
to you is besides the THRIVE Act--and we thank you for your
words of support for more Section 8 vouchers for addiction
recovery, but you mention the CDBG program, the Community
Development Block Grant, and I fully agree with you that
recovery is community development because of the connection to
the workforce development issue.
What statutory changes does the Congress need to make,
continue to make besides the THRIVE Act to provide more CDBG
funds or other resources to take the Recovery Kentucky model
nationwide?
Mr. Fletcher. That is a tough question. Congressman, let me
say this. As I have thought about the CDBG grants, 15 percent
of those are available for service, and we are using those, but
they are very competitive because most of the communities out
around the State, knowing that these funds are controlled
primarily by the Governor, make it very difficult to direct
some of these moneys to a recovery effort.
I do think, maybe similar to what you are doing in the
THRIVE Act under the CDBG funding, is looking at considering
setting aside, taking some of that $6 billion that is going and
set aside for community development similar to the CAREER Act
but making sure there is a funding stream available that is
sustainable, that helps us address directly that particular
need. That could be tied with the quality measures that you
have already done in the THRIVE Act. It could be tied with
making sure that they have job training, that they are involved
with the local economic development, all part of this healing
community effort.
What particular piece of legislation? I think the CAREER
Act might be a place, but looking also at the--I guess the
appropriations for CDBG but the authorization for CDBG and
where those come from and looking at the language in that
authorization bill to see if we couldn't specify, as you have
done in the THRIVE Act, some moneys for that particular
development effort.
Mr. Barr. Thank you. That is helpful.
Mr. Boggs, I appreciate all the good work that you all do
at OWL to take people from a period of incarceration into
sustainable employment. Do you have any specific suggestions
for how Federal housing programs can work more closely with
nonprofits like yours to help residents find jobs and rise
above poverty? And the question is animated by my own personal
experience traveling the central Kentucky area and talking to
employers.
And, Mr. Thomas, you made a great point about providing
sober workers. It is ubiquitous. Every single employer in
central Kentucky, whether it is a farm, whether it is a
manufacturing firm, whether it is a healthcare-related
business, whatever the business is, the hiring manager, the
H.R. manager, the plant manager, they all tell me the same
thing, which is we have job openings we can't fill because
people can't pass a drug test. How can Federal programs partner
more with organizations like you to provide that labor supply?
Mr. Boggs. Yes. As I mentioned several times, the
correlation between housing and employment is so critical
because of--simply for the fact if people do not have a place
to stay, they do not feel like getting up and going to work in
the morning. They are not capable of getting up to work in the
morning. So if they have stable housing, then that provides
them a place, a residence, a place of safety that enables them
to go to a place like OWL and receive the necessary job
training.
And you are correct; every individual that comes through
our doors that wants to work, we can find employment for them.
The big issue is so many times they come to work and then the
next day they don't show up. That is because they don't have
transportation. That is another big barrier that goes in this
whole piece that none of us have mentioned today. So getting
back and forth to work and having that stable place to live
brings that full circle together.
And when we do have partnerships like I stressed earlier,
that makes it so meaningful to connect it all together, and the
collaboration is going to be the ultimate key for all this
among agencies and maximum utilization of dollars.
Mr. Barr. Mr. King, can you expand on how the current cap
on project-based vouchers--you mentioned the 20-percent cap--
has limited specifically here in Kentucky. How has that limited
the Kentucky Housing Corporation's ability to invest in housing
programs that serve those who are recovering from opioid
addiction?
Mr. King. Yes, and when I--thank you. When I mentioned that
earlier, there are PHAs throughout the Nation who have done
some demonstration projects where they can exceed that 20-
percent cap. However, Kentucky Housing Corporation is not one
of those. What you have seen in Kentucky is 14 recovery centers
that do great work, but they all use housing choice vouchers
that are project-based to those centers, so you have those 14
recovery centers. You also have, I believe, 13 Scholar Houses,
which I just mentioned a little bit earlier where, again, those
vouchers are attached to those projects.
So these have been very innovative approaches to address a
particular issue like the opioid epidemic and like education
and workforce training. However, because of those efforts, we
have hit that cap. And so allowing us more flexibility, maybe
increasing that 20-percent cap to potentially 40 percent or
greater, to me it presents an option for States to utilize
those resources. I think we have to take--as a country, I think
we have to take a holistic approach to housing, and we can't
just look at providing a roof over somebody's head. We have to
address the things that lead to chronic homelessness like the
opioid addiction epidemic and like educational opportunities
for parents. So by raising that cap, we are allowed to target
individuals into particular housing models.
The purpose of the housing choice voucher was a good
purpose, to give people choice in where they want to live. That
is a good and noble goal. The problem is that you have a lot of
landlords who are not willing to take tenants. So someone might
get a voucher and they might not be able to find a house to
live in because there are no landlords that will take them. So
by increasing that, you are guiding them into a particular
project.
We administer at Kentucky Housing approximately 4,600
vouchers, Housing Choice Vouchers. There is a waiting list of
5,600. So while the increase in cap, the 20-percent cap would
be beneficial, vouchers are the single most effective resource
to address a homelessness issue, so obviously increasing those
would certainly help.
Mr. Barr. Thank you for your testimony, Mr. King, and I
look forward to working with you and the Kentucky Housing
Corporation to address that arbitrary statutory cap and looking
forward to working with Chairman Duffy to achieve that once we
get the THRIVE Act signed into law.
Ms. Minton, you talked a lot about--and we applaud the
great work of the Chrysalis House and what you do for women and
newborns suffering from neonatal abstinence syndrome. And we
want to work with you on the problems that you described with
HUD. We want to fix those problems, so I look forward to
working with you on that. That is precisely why we introduced
the THRIVE Act, to provide alternative resources to replace
some of the funding that you lost. And I think your respectful
pushback of the Housing First program I think is appropriate
for us to take into consideration as we exercise oversight over
HUD and encourage HUD to reevaluate the priorities and the need
for more transitional housing services.
But my question to you, Ms. Minton, is because you are at
the frontlines of the neonatal abstinence syndrome issue, could
you just describe for the record, at least here in central and
eastern Kentucky, the dimension of the problem of women who
come to you with newborns who are suffering from this problem?
Ms. Minton. Well, Chrysalis House prioritizes pregnant
women, so we try to get the women in before the baby is born,
and that we are working with U.K. PATHWAYS and Beyond Birth to
ameliorate the effects so that the baby is born healthy or as
healthy as possible. And so we are working closely with the
doctors.
And Lindy left, but we have our board meeting tonight at 6
o'clock to officially vote on opening a new 16-bed facility on
the grounds of Eastern State Hospital for 16 pregnant and
postpartum women, working very closely with U.K. PATHWAYS and
Beyond Birth, and so we will have access to MAT services--the
buildings are right next door on the campus--and hep C services
because that is another problem with many of the women that we
work with, and just trying to partner as best we can to help
the women and their babies because they do recover and they do
get better.
I think that one of the things that Dr. Walsh alluded to is
the number of women in rural Kentucky who do come to Lexington
for services but are often reluctant to enter into treatment,
especially long-term treatment. And so that is one of our
obstacles that we are working on, and trying to do the
telehealth I think is making great strides for our State.
Mr. Barr. Thank you. Mr. Robinson, thanks for your powerful
personal testimony, and I wanted to ask you from your
experience, do the program participants that you contemplate
coming into your program, how will they have success finding
work, and how will they have success moving out of government
assistance? What are some of the factors that will, in your
judgment, lead to hope and thriving as you say, as opposed to
just getting by?
Mr. Robinson. Well, there has been a big effort for reentry
programs, whether that is helping people transition out of
prison or transition out of 30-day treatment programs or detox
facilities. We have put a lot of effort there. And the problem
is that often when that person leaves jail, if they leave a 30-
day treatment program, there is a big gap from that moment when
they walk out the jail cell, they walk out the treatment center
until they are able to even be employed. And there are some
things on the life skills side; there are some things on
financial literacy. Those things have to be a part of that gap
between when they come in crisis to putting them in a career.
The other thing is you have to get them on a path where
they can see a career path that is better than a petty drug
dealer because we compete in their mindset with why should I go
work a minimum wage job when I can do one petty drug deal. And
so the hope has to be a real hope. It has to be a real economic
opportunity. It has to be that you can become somebody who can
support yourself, support your family, and we are not competing
with that.
And so I think having wraparound services like what the
Shepherd House is doing, what we are doing, what others are
doing, Recovery Kentucky, to get people in that zone where we
lose most of them and make sure they have peer support, make
sure they have counseling, make sure that they have people that
really are reparenting them because a lot of the things that we
do we take for granted, getting up every morning, knowing what
is appropriate to wear to work. If we leave that to them when
they have never done that, we are setting them up to fail. So
our efforts, whether it is MAT, whether it is abstinence,
whether it is whatever, all of those are going to require us to
have transitional housing, workforce development.
One of the things in the CAREER Act is not only giving more
targeted project-based vouchers, not only giving more targeted-
based community block grants, but giving targeted workforce
development, that the WIOA funds have a certain amount that are
targeted for people coming out of addiction because I have seen
time and time again if somebody doesn't have that hope, then
they are going to go right back to petty drug dealing, and it
is not going to be long before they are going to relapse and
they are going to be right back in the mess that we have
already once rescued them out of. Instead, if we will make the
investment with a whole-person approach, we can see them
succeed.
Mr. Barr. Thank you for that. And, Mr. Thomas, first of
all, let me just address Donna and express my condolences to
you for the loss of your son Luke, and that is exactly why we
are here today. Luke is exactly why we are holding this
hearing, and we want to make sure that we bring every resource
to bear from Congress to prevent this happening to any other
family.
And the Shepherd's House is a wonderful program that needs
resources, and Congress has responded to this epidemic with
billions of dollars in appropriations, but guess what? Not all
of the resources that we have appropriated are actually
addressing the transitional housing need. And so I fully, fully
agree with Mr. Thomas' testimony that we need to make sure that
there are no shortages of beds, and we need to rethink all of
the priorities within the context of these appropriations so
that organizations, not-for-profits like Shepherd's House, are
eligible to receive some of the resources. And again, that is
what is motivating the THRIVE Act.
So, Mr. Thomas, you mentioned no Federal funding to the
Shepherd's House outside of some Federal Home Loan Bank and KHC
funds. How would the THRIVE Act specifically help Shepherd's
House and similar programs?
Mr. Thomas. Point-blank, it is a game-changer. I spent a
ton of time reading it and researching it. We made a joke in
getting ready for this. We are at the Shepherd's House, we are
the forgettables. And by that I mean, my clientele falls
through the cracks. We don't qualify for anything. I understand
why pregnant ladies will go first. It makes absolute sense to
me. But again, we are getting left behind. We are the
forgettables. So our guys fall through the cracks.
But what I love about it, what I love about the THRIVE Act,
I think it was the fact that it ties it all together as the
whole person as opposed to just addressing one issue because
that is what always happens to a drug addict now. It is always
one issue that takes them out, so you get them sober, but then
they don't have anywhere to live so they get high. Well, you
get them sober and then it turns out they are bipolar and you
didn't provide them any mental health services, so they
relapse. You get them sober and they get fired from their job
and they can't get another job, so they get high.
The thing I love about the THRIVE Act is it ties it all
together and it allows us to work as a team on this panel with
the THRIVE Act. So now, when you are putting them and giving
them vouchers for a place to live, you are not just saying here
is your money, good luck. You are saying here is your money,
here is peer support, here is job training, here is mental
health counseling, here is individual counseling, here is group
therapy. Well, now, you have provided them with all the tools
they need to take that voucher.
And eventually the endgame always has to be--I would
honestly say this and hope not to offend, but if I had a guy
that was 10 years' sober still living in Section 8, I would be
extremely upset because the endgame has to be move them on in
life. And I think that gives them the start that they need. And
I thought it was genius. I am so excited about it, so thank
you.
Mr. Barr. Well, thank you for the testimony.
And, Dr. Walsh, we want to get to Congressman Guthrie here,
so just a quick comment and a quick question. The comment is a
follow up from Chairman Duffy's exchange with you about pain
management reimbursement and narcotics avoidance. The American
Society of Anesthesiologists and some anesthesiologists in
Kentucky are doing some groundbreaking work on enhanced
recovery after surgery. We need to pursue that. I think
Congress needs to appropriate funding to tie narcotics
avoidance to pain management, and we need to work with our
physician community to do that. So I appreciate the fact that
the accreditation standards may be revisiting that issue, and I
want to work with you and U.K. and other healthcare facilities
to achieve that.
The question is, following their treatment at the
University of Kentucky--and the PATHWAYS program is a wonderful
program; I had the privilege of visiting with the fine people
there at U.K.--are there currently sufficient housing options
for these women and their babies to have a safe place to live
in a sober environment?
Dr. Walsh. So I think that, overall, hearing from the other
panelists that there are insufficient opportunities for
housing, when we hear about waitlists and the need for an
additional, what was it, over 4,000 vouchers to meet the needs.
And so we really need expanded access, but we need expanded
access to meet people where they are.
So, for example Chrysalis House, which is an outstanding
program, allows women with their children. Many programs don't
allow that. As I said in my testimony, many programs will not
allow people who medication is part of their recovery to
participate in their programs. And I think that we need to
align what it is that we know from the evidence that works.
Let me be clear: My position is not that medication is the
sole answer, but it is an important component. And so I think
that for places to actually make a decision and say we are
going to exclude this evidence-based practice that has been
endorsed by the Federal Government and not allow that in their
setting I think is a disservice to the patients that we are
trying to reach. So I think that we need additional resources,
but we also need to have a more integrated approach.
And so Mr. Thomas just talked about integrating and
everyone is talking about holistic, but I think that we really
need to think about who the patients are, where they are, and
then what unique things they bring and then loosening up some
of the reins around some of the restrictions that we put on
some of the programs. And some of them are from within.
Mr. Barr. Thank you, Dr. Walsh. And my time is more than
expired, but again, as I yield back, I want to thank Chairman
Duffy for coming all the way from Wisconsin to be with us in
Kentucky, for your leadership on this issue, for helping as you
chair the subcommittee, moving the THRIVE Act through the
markup process and off the House floor over to the Senate.
Thank you for your continued dedication and commitment to this
very important issue.
And, Congressman Guthrie, thank you as well for your
leadership and for joining us here today in Lexington.
I yield back.
Mr. Duffy. The gentleman yields back.
The Chair now recognizes the other gentleman from Kentucky
from the Energy and Commerce Committee, a Ranking Member on the
Health Committee, also the author of the Comprehensive Opioid
Recovery Centers Act, which passed the House almost
unanimously, but like many other bills, is still waiting action
I believe in the Senate.
Mr. Guthrie. Right.
Mr. Duffy. That is the story of our life.
With that, the gentleman from Kentucky, Mr. Guthrie, is
recognized for as much time as he may consume.
Mr. Guthrie. Thank you very much. I appreciate it. I guess
I should take back all my nice comments about Wisconsin after
your comment about that ballgame, but, no, it is great. It is a
great rivalry. It is a great rivalry.
So I was going to ask my first question, and I think it has
really been answered. But I think, Mr. King, since you are in
the housing world more than the recovery world really, just
what specifically the THRIVE Act was empowering you to do that
you can't do now. I know a lot of people--so we come to the
agreement, we all agree, and then I said earlier that leaving
inpatient care and going into sober living is vital. So what
specifically does the THRIVE Act allow you to do that you can't
do now?
Mr. King. Well, I think the THRIVE Act goes directly to the
participants. It is a set-aside of the Housing Choice Vouchers,
and it goes directly to the nonprofits.
Mr. Guthrie. The Section 8 isn't administered to you at
all?
Mr. King. It is a portion, I believe, the funds. And I--
Mr. Guthrie. OK. So I thought Section 8 probably went
through you guys as well, but it doesn't, so--
Mr. King. No, it--
Mr. Guthrie. I am not on this committee so--
Mr. King. It--
Mr. Guthrie. --I don't know how Section 8 was administered
through--
Mr. King. Yes. But I think it is good in the fact that it
targets a need for housing in recovery services. And again, it
goes back to my suggestion that we increase that cap of 20
percent because we need to target specifically those
individuals in recovery.
Mr. Guthrie. So it would help your specific role to do it
more than this specifically?
Mr. King. Yes. And I would say that by increasing that cap,
I can do more at KHC in line with the THRIVE Act.
Mr. Guthrie. Oh, perfect. Great.
So, Dr. Walsh, I am interested in the First Bridge Clinic
you were talking about earlier. So I am on the Healthcare
Subcommittee of Energy and Commerce, and we had a group of 10
parents that came in that had lost a child and one that
specifically just--so when you talk about 50 bills, well, what
are you doing in 50 bills instead of one big bill? But there
are a lot of different things we found were roadblocks.
And we had one family from New Jersey that specifically
said they got a phone call that their son had overdosed and
passed away. They didn't get the phone call from the emergency
room until they came to pick up his body. That was actually his
eighth trip to the emergency room, and he was over 18. He was a
college student. They were paying his bills. He was on their
insurance. The parents were still completely responsible for
him, but by law, he was an adult.
So because of HIPAA (Health Insurance Portability and
Accountability Act), that is what we are trying--some privacy.
We understand the privacy side, but we also understand that
parents are wanting the information, too, of their child. And I
don't know the specifics of every trip to the emergency room,
but you leave yourself going, if somebody has been there 8
times, is there not some connection between the emergency care
and getting them into care? So exactly--if you want to further
talk about First Bridge, I would love to hear a little more.
Dr. Walsh. Sure. I am happy to talk about that. But if you
don't mind, I will just reflect on what you just described
because what you are describing is exactly what is happening
all over the country. So people come in and out; it is a
revolving door. The emergency department staffs are completely
overwhelmed, and in many places they have absolutely nothing to
offer to people, so they really are just treating them and then
getting them out the door. People will come, they will be
reversed with their overdose in the ambulance. They won't even
come in the door. They don't want to be at the hospital. So we
are not really making that connection at that very critical
time when we have identified someone who is at high risk.
I can tell you it is actually even very difficult for us to
count accurately the number of overdoses that are occurring
within any hospital system because we are not even necessarily
testing people's urine to determine that they have opioids and
that is the cause of the overdose because if you give them
naloxone and it works, then you know that is what it is, and
they just send them back out. So at every level this has just
been an incredible challenge.
And what we are trying to do with the First Bridge Clinic
is really provide an immediate warm handoff, and that way,
within an integrated system, the physician can identify that
this person has either an overdose or maybe they have an ulcer
from injecting drug use or some other thing that alerts them to
the fact that the person has an opioid issue. They can do a
pulldown on the computer to do an electronic referral directly
to us. If they reach out to us from the emergency department,
we have actually spoken to patients from their beds in the
emergency room. We can get hospital transportation to bring
them to our clinic, and we can try to start them on treatment
right away.
We have just started the clinic in January. We now have 5-
day-a-week coverage. We are working on having some walk-in
hours so people don't have to deal with making an appointment
even; they can just show up.
I can tell you the issue that you are raising about adult
children whose parents are still really the caretakers, a lot
of patients we have are brought in by their parents. They are
adults, but they are brought in by their parents, and they sit
in the waiting room and they have an argument about things, and
then the person with the disorder leaves. They don't want to be
there. They feel like they are being coerced, and the parents
really have no influence.
And the HIPAA issue is not just that the systems aren't
connecting. This area of medicine is so completely separate
from everything else. If someone is in a methadone program, we
don't have any way of knowing that in our program because that
is also siloed by Federal law. So I think that we need to come
up with some creative solutions for figuring out how we can
move forward to actually empowering people to get the help that
they need for their family members.
I know Massachusetts is working on a law that would
actually require people to be forced into care. I am not one
personally who agrees with that, but I think people are looking
at innovative solutions so that we can try to help people who
either are failing to recognize that they need help but really
are on the verge of a complete crisis or death.
Mr. Guthrie. Yes, trying to get that information where
emergency rooms will have that information because you are
right; it is siloed. If you are in treatment or have drug
issues, it is not in the medical records by law.
Dr. Walsh. Even if it is in the same health system.
Mr. Guthrie. Exactly. And so actually what is interesting,
one of these 50 bills is on specifically--and you couldn't have
two different Members of Congress. There is one gentleman from
Portland, Oregon, who would be more you would describe to the
left, another from Oklahoma would certainly be described more
conservative, to the right, and those two together--and the
debate was not really Republican/Democrat, left/right. It was
more different groups on privacy versus practicality of having
this done. And that bill did pass. It is in the Senate. So it
is interesting. I think a lot of people outside of Washington
think everything is just always a battle, but there are groups
of people who have different opinions on other things that come
together and they have common solutions. And that bill has
passed.
And I guess I am going along, but what is interesting as I
walk into every--so I told you the last couple of weeks I have
been going to recovery centers, and you hear the patients
there, the people talking, it just seems like everything is
working well.
I did bring up the--you talked about the 16 beds. That is
by Medicaid law, and we are looking for opioids, expanding
that, because I saw one place that had an eight-bed room and an
eight-bed room and a different administration so they could
have--or that is eight beds, 16--or eight rooms had two to a
room, so they essentially had 32, but they were trying to get
around the law. We need to fix that so people aren't having to
game it to get things done.
But the point we were talking about opening that 16-bed
exclusion or limit for opioid, and it should be for more but it
is just funding I guess we get back to. But one person when I
said that, well, if you do that, people just create these big
warehouses that have 100 beds. They will have people in them
and not get the treatment.
So the question--and in those--so, Dr. Walsh, this is for
you. In those 10 families we had, there was one specific
family. They had different issues they were trying to address.
And one family, typically from high-income families, I will
spend anything it takes to get my child--so they were from New
Jersey as well, suburban New York, and they were very high-
income family, and whatever it takes, and so they sent their
child to Florida, had passed away. It is everywhere, not just
Florida, but it seemed to be an industry down particularly in
southern Florida where it was like patient brokering, which was
new to me where the intent didn't seem--this parent said that.
I am not saying it because I don't know, but the parent said
the intent didn't seem for their son to get out, but son just
to go from one to the other to the other as long as they were
paying.
And so I guess to get into if we are going to warehouse--
the ones I have seen I have been impressed with, but how do we
know a good one? I have a bill called the Comprehensive Opioid
Recovery Centers to try to sort out how do we--what kind of
evaluations they do in placement, be longer than a few-minute
answer. But kind of in just--the THRIVE program, the THRIVE
Act, because it is demonstration, how should we judge these
things and test them and evaluate them?
Dr. Walsh. That is a very important question, and there
really isn't a standard. And I can tell you that the American
Society of Addiction Medicine does have standards of care, and
they have different levels of care that they define that may be
needed depending on the severity of the disorder. And you could
use that framework, and people have talked about using that
framework to try and grade treatment facilities.
However, the problem at least here in Kentucky is that we
only have a few of those levels of care. We don't have the
whole complement based on what the ideal circumstance would be.
We are not the only ones, though, so I do think that there are
evidence-based practices that have been defined and they are on
the website for SAMHSA. We know what they are. I think that we
can start by developing guidelines that check off those boxes
and that actually are doing the monitoring that is necessary.
So when somebody is saying that people are successfully
abstaining, then I want to see your drug screen results from
that. I don't want to see just self-report. So, like Mr. Thomas
said, when they are linking with an employer, they are testing
people 3 times a week, they know exactly what is happening.
That is not occurring in all settings.
In some of the treatment programs, there is a lot of drug
use that goes on. And I am not talking about anybody that is at
this table. I am just saying that there are places where, as
you described, they are in it for the profit, and they are less
concerned about the well-being of people as long as they are
getting care.
There was a big expose about some of those programs in
southern Florida, and there is some suggestion that those same
places that were pill mills before have been shut down, and now
this is a different business model for them. We know that there
are a lot of overdoses, fatal overdoses that take place in some
of these programs. They are not publicized. That is not a good
outcome when that happens. But oftentimes, people are not made
aware of it.
So I think that we can take what we know from the
scientific literature about how one would do a study to assess
the efficacy of a treatment and borrow those same types of
monitoring practices and implement them and customize them for
recovery houses and for treatment programs for residential
because we know what the goals are. If the goals are to get
jobs, if the goals are to get somebody so that they are
surviving, these are really objective markers. But I think then
you want some external source doing that evaluation. You don't
want to necessarily have people reporting on their own without
some external evaluation.
Mr. Guthrie. Thank you. And I am not going to ask another
question, but I just want to say I know Mr. Robinson has been
to Washington to testify. Mr. Boggs, I appreciate what you guys
do specifically, and all of you.
I am also on the Education and Workforce Committee,
Chairman of the Higher Ed Subcommittee that has the
jurisdiction of the Workforce Investment Act or WIOA
Opportunity Act, and so it is all vital to tie together. And I
think you are seeing all sides in Washington. As Chairman Duffy
said, we are all agreeing that we need to put this together,
and I think once we know we are paying for the good programs
and the funding, we want to make sure we are, the funding is
following, and so there is a lot of work to be done but a lot
of effort is being done and a lot of--trying to understand it
and trying to comprehend it and trying to move forward and
getting--and I am left convinced, getting people into sober
living is probably our most critical part now because we have a
lot of residential treatment. There may be a waiting list for
them but not a big control on the sober living side of it, and
so I appreciate Congressman Barr's leadership and appreciate
everybody coming together to talk about that because this is
important to highlight.
Thank you, Mr. Chairman, and I yield back.
Mr. Duffy. The gentleman yields back.
I want to again thank our panel for their participation in
today's hearing. I want to thank Chairman Barr for all the work
he did in putting this hearing together, making sure we had a
well-rounded panel, providing us excellent insights.
If I could make one parting note, the best ideas for
legislation come not from Washington, it comes from all of you
who are on the frontlines doing this work. And there is a great
partnership that happens. If you have an idea and you get it to
Mr. Guthrie, Mr. Barr, or myself and we introduce it, one, we
have stolen your idea and we look really smart; and two, you
get your idea into legislation. But in the end we are helping
people. We are getting the right bills, the right legislation
that do the most to help the most vulnerable among us, and that
is what is really critical here.
And I just want to thank all of you for the work that you
do, for taking the time out of your day to participate in this
hearing so we can take the information garnered in this hearing
back to our colleagues in Washington. So thank you for your
time and your effort and your good work.
Without objection, all members will have five legislative
days within which to submit additional written questions to the
chair, which will be forwarded to our witnesses. If we have any
of those additional questions, I would ask the witnesses to
respond as promptly as feasibly possible.
With that, and without objection, this hearing is now
adjourned.
[Whereupon, at 11:05 a.m., the subcommittee was adjourned.]
A P P E N D I X
August 16, 2018
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
[all]