[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]




 
                      EXAMINING THE 2022 NATIONAL

                     DRUG CONTROL STRATEGY AND THE

                        FEDERAL RESPONSE TO THE

                            OVERDOSE CRISIS

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

                                HEARING

                               BEFORE THE

                              COMMITTEE ON
                          OVERSIGHT AND REFORM
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             JUNE 27, 2022

                               __________

                           Serial No. 117-90

                               __________

      Printed for the use of the Committee on Oversight and Reform
      
      
      
      
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]       
      


                       Available on: govinfo.gov,
                         oversight.house.gov or
                             docs.house.gov                             
                             
                          ______                       


             U.S. GOVERNMENT PUBLISHING OFFICE 
47-929PDF           WASHINGTON : 2022                             
                             
                             
                   COMMITTEE ON OVERSIGHT AND REFORM

                CAROLYN B. MALONEY, New York, Chairwoman

Eleanor Holmes Norton, District of   James Comer, Kentucky, Ranking 
    Columbia                             Minority Member
Stephen F. Lynch, Massachusetts      Jim Jordan, Ohio
Jim Cooper, Tennessee                Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia         Jody B. Hice, Georgia
Raja Krishnamoorthi, Illinois        Glenn Grothman, Wisconsin
Jamie Raskin, Maryland               Michael Cloud, Texas
Ro Khanna, California                Bob Gibbs, Ohio
Kweisi Mfume, Maryland               Clay Higgins, Louisiana
Alexandria Ocasio-Cortez, New York   Ralph Norman, South Carolina
Rashida Tlaib, Michigan              Pete Sessions, Texas
Katie Porter, California             Fred Keller, Pennsylvania
Cori Bush, Missouri                  Andy Biggs, Arizona
Shontel M. Brown, Ohio               Andrew Clyde, Georgia
Danny K. Davis, Illinois             Nancy Mace, South Carolina
Debbie Wasserman Schultz, Florida    Scott Franklin, Florida
Peter Welch, Vermont                 Jake LaTurner, Kansas
Henry C. ``Hank'' Johnson, Jr.,      Pat Fallon, Texas
    Georgia                          Yvette Herrell, New Mexico
John P. Sarbanes, Maryland           Byron Donalds, Florida
Jackie Speier, California            Vacancy
Robin L. Kelly, Illinois
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts

                      Russ Anello, Staff Director
         Miles Lichtman, Deputy for Health Oversight and Policy
                       Elisa LaNier, Chief Clerk
                      Contact Number: 202-225-5051

                  Mark Marin, Minority Staff Director
                                 ------                                
                         C  O  N  T  E  N  T  S

                              ----------                              
                                                                   Page
Hearing held on June 27, 2022....................................     1

                               Witnesses

Dr. Rahul Gupta, Director, Office of National Drug Control 
  Policy, Executive Office of the President
    Oral Statement...............................................     4

 Opening statements of the Members, and the prepared statement 
  for the witness are available in the U.S. House of 
  Representatives Repository at: docs.house.gov.

                           INDEX OF DOCUMENTS

                              ----------                              

The documents listed below are available at: docs.house.gov.

  * Letter from Rob Boothe, Lieutenant, Spokane Police 
  Department; submitted by Rep. Comer.

  * Letter from Brent White, Sheriff, Lyon County Sheriff's 
  Office; submitted by Rep. Comer.

  * Letter from Matthew Thomas, Chief Deputy, Pinal County 
  Sheriff's Office; Rep. Comer.

  * Letter from Philip Welch, Chief of Police, Coon Valley Police 
  Department; submitted by Rep. Comer.

  * Letter from Brendan F. Kelly, Director, Illinois State Police 
  re Opioids; submitted by Rep. Comer.

  * Letter from Don Barnes, Sheriff-Coroner, Orange County 
  Sheriff Department, re: Impacts of Fentanyl on Local 
  Communities; submitted by Rep. Comer.

  * Arizona News-U.S. News, article, ``Cops: 500,000 Fentanyl 
  Pills Found in Arizona Traffic Stop''; submitted by Rep. Biggs.

  * List of 117th Congress Hearings Held with Biden 
  Administration Officials; submitted by Chairwoman Maloney.

  * Study of the Impacts of Massachusetts Narcan Distribution 
  Program; submitted by Rep. Tlaib.

  * U.S. Customs Border Protection Report; submitted by 
  Chairwoman Maloney.

  * President Biden 2021 Executive Order, re: Transnational 
  Cartels and Drug Traffickers Sanctions; submitted by Chairwoman 
  Maloney.

  * Questions for the Record: to Dr. Rahul Gupta; submitted by 
  Rep. Holmes Norton.


                      EXAMINING THE 2022 NATIONAL

                     DRUG CONTROL STRATEGY AND THE

                        FEDERAL RESPONSE TO THE

                            OVERDOSE CRISIS

                              ----------                              


                         Monday, June 27, 2022

                  House of Representatives,
                 Committee on Oversight and Reform,
                                                   Washington, D.C.
    The committee met, pursuant to notice, at 1:40 p.m., in 
room 2154, Rayburn House Office Building, and via Zoom; Hon. 
Carolyn Maloney [chairwoman of the committee] presiding.
    Present: Representatives Maloney, Norton, Lynch, 
Krishnamoorthi, Raskin, Khanna, Mfume, Tlaib, Wasserman 
Schultz, Welch, Johnson, Kelly, DeSaulnier, Comer, Foxx, 
Grothman, Cloud, Norman, Biggs, Fallon, and Donalds.
    Chairwoman Maloney. The committee will come to order.
    Without objection, the chair is authorized to declare 
recess of the committee at any time.
    I now recognize myself for an opening statement.
    Today's hearing focuses on an issue of urgent importance to 
Congress, to families across the country, and to me personally: 
overcoming the addiction and overdose crisis that continues to 
ravage communities in every part of the United States. As chair 
of this committee, I have worked to ensure that every person 
dealing with addiction can access comprehensive treatment and 
care. And when it comes to the bad actors that fuel this 
crisis, like the Sackler family, the Purdue Pharma, and 
McKinsey, I have used this gavel to hold them accountable for 
their actions.
    This hearing comes at a very difficult moment for our 
Nation. Overdose deaths in America have been rising for more 
than two decades, and during the coronavirus pandemic, fatal 
overdoses skyrocketed to historic levels. Tragically, overdose 
deaths increased by more than 30 percent in 2020, and by 
another 15 percent in 2021 when more than 100,000 lives were 
lost. The Biden-Harris Administration and Democrats in Congress 
have taken aggressive action to address both the supply and 
demand factors contributing to this crisis. Since President 
Biden took office, we are stopping more fentanyl at the border 
than ever before. This administration has increased drug 
interceptions, seizing roughly 800 pounds of fentanyl each 
month. This represents a fourfold increase in fentanyl 
interdiction over the previous administration's efforts in 
2019. To build on this progress, President Biden's 2023 budget 
calls for more than 10 percent in additional funding for 
interdiction efforts, a request I hope all my colleagues will 
support.
    At the same time, the Biden-Harris Administration and 
Congress have made significant progress in treating addiction 
as the disease that it is by expanding access to treatment and 
wraparound services. The American Rescue Plan allocated nearly 
$4 billion to services for mental health and substance use 
disorder. That law also created the first Federal fund for harm 
reduction services. Additionally, the administration's Overdose 
Prevention Strategy has invested tens of millions of dollars in 
initiatives to reach underserved communities, combat stigma, 
and expand access to lifesaving treatment. These programs save 
lives, and I am grateful that this administration has 
prioritized them.
    Today, we will hear from Dr. Rahul Gupta, the director of 
the White House Office of National Drug Control Policy, who 
will testify about the Biden administration's 2022 Drug Control 
Strategy. This National Strategy focuses on what works. It uses 
evidence-based strategies to build on the progress already made 
by the Biden administration, and it outlines a plan to invest 
in communities, prevent substance misuse, and increase access 
to treatment and recovery services. The National Strategy takes 
bold steps to ensure that medication to reverse overdoses is 
available to anyone in a moment of crisis, a strong bipartisan 
priority that will save lives. The Strategy promotes access to 
fentanyl test strips which are a vital tool for overdose 
prevention, especially among young adults. The National 
Strategy also builds on the administration's progress to 
disrupt the supply of dangerous substances into the U.S. by 
targeting transnational criminal organizations that are 
manufacturing and trafficking fentanyl.
    This year's National Strategy also goes further than any 
prior drug control Strategy to address structural inequities 
that lead people in some communities with insufficient access 
to healthcare and makes them more likely to be pulled into the 
criminal justice system as a result of drug misuse.
    The overdose crisis affects every community, represented by 
our committee members here today, both Democrats and 
Republicans. We owe it to our constituents to do everything we 
can to build on the administration's progress and work together 
to advance solutions to this public health crisis. That 
includes sending to the President's desk the strong bipartisan 
mental health and substance use disorder package that the House 
approved last week. It also means passing H.R. 6311, the CARE 
Act, a bill I authored and introduced with Senator Elizabeth 
Warren and others, that advances the objectives of the National 
Drug Control Strategy by providing crucial resources to the 
local communities on the frontlines of this public health 
crisis.
    I thank Director Gupta for appearing before the committee 
today and for the Biden-Harris administration's continued 
commitment to ending our Nation's overdose crisis.
    I now yield to my good friend, Ranking Member Comer, for 
his opening statement.
    Mr. Comer. Thank you, Chairwoman Maloney, for calling this 
hearing today. Our committee's mission is government efficiency 
and effectiveness. Our committee's mission is to protect 
taxpayer dollars from government fraud, waste, and abuse. Our 
committee's mission is to hold government officials 
accountable. Republicans on this committee have been pushing 
for months to hold hearings on the many pressing crises caused 
by the Biden administration. While I am pleased we finally have 
a top-level Biden official testifying today, I must say this is 
long past due. I urge the chairwoman to hold more hearings like 
this one where we can examine the many crises impacting America 
today. Thank you, Dr. Gupta, for testifying today.
    In January, Republicans on the Oversight and Energy and 
Commerce Committees launched an investigation into America's 
fentanyl crisis. We sent letters to the Office of Drug Control 
Policy, Customs and Border Protection, and the DEA seeking 
information about the Biden administration's plan to address 
the crisis at the Southern border and overdose epidemic. We 
appreciated the response from your Agency, Dr. Gupta, but many 
important questions remain unanswered. One of these outstanding 
questions is how President Biden's border crisis and this 
administration's open-border policies have aided and abetted 
trafficking of illicit drugs, such as fentanyl, into our 
country. Fentanyl is being smuggled across the southwest border 
at unprecedented rates. U.S. Customs and Border Protection 
seized over 11,000 pounds of fentanyl in Fiscal Year 2021. That 
is more fentanyl seized in one Fiscal Year than fiscal years 
2020 and 2019 combined.
    The standard fatal overdose of fentanyl is 2 milligrams. 
Eleven thousand pounds of fentanyl is more than 5 billion 
milligrams. That means we seized about 2.5 billion lethal doses 
of fentanyl in one fiscal year. That does not include all the 
fentanyl that we know has been smuggled across our borders 
undetected. Cartels are overwhelming Border Patrol Agents and 
providing a steady supply for dealers and users alike. So, a 
primary question is, what is President Biden going to do to 
secure the border and cutoff the free flow of illicit drugs 
into our country. We also wrote an open letter to law 
enforcement seeking information about how the fentanyl crisis 
is impacting local communities. We received distressing 
responses from communities across the country. They tell us of 
the devastating effects fentanyl has had, of young lives lost, 
and families destroyed.
    Madam Chairwoman, I ask unanimous consent to submit these 
response letters into the record.
    Chairwoman Maloney. Without objection.
    Mr. Comer. Thank you. On top of the crises at the Southern 
border, Democrat lockdowns and school closures caused increased 
stress and mental health complications for teens and adults 
alike, leading to historic overdose rates. According to 
preliminary data from the CDC, more than 107,000 people died 
from a drug overdose in the U.S. in 2021. That is a nearly 15-
percent increase over 2020 which is already a 31-percent 
increase over 2019.
    Our Nation's mental health crisis continues to worsen due 
to the economic hardship and supply chain crises caused by 
President Biden's disastrous policies. Studies have shown that 
stress over money can make people up to 20 times more likely to 
attempt suicide. Inflation remains at a 40-year high, gas 
prices are the highest in American history, and many families 
are stressed, wondering how they are going to make ends meet.
    Tragically, fentanyl overdoses are becoming the leading 
cause of death for Americans aged 18 to 45, more than COVID, 
car accidents, gun violence, breast cancer, or suicide. 
Teenagers and young adults are turning to Snapchat, TikTok, and 
other social media apps to find Xanax and other pills, many of 
which are counterfeit and laced with fentanyl. Fentanyl has 
also been found in counterfeit vape pens and marijuana. We must 
act now to secure our Southern border to stem the flow of 
illicit fentanyl. It is heartbreaking to see how desperately 
people are trying to escape the impacts of President Biden's 
policies. His administration has flooded the market with 
illicit drugs, so they can do just that.
    Thank you, Madam Chair. And I yield back.
    Chairwoman Maloney. The gentleman yields back. Thank you 
very much. And I would note in response to your statement that 
we have already held more than 25 hearings this Congress with 
Biden administration officials and other government witness. 
Today is the 26th. I have a list of these hearings.
    Without objection, I will enter it into the record.
    Chairwoman Maloney. And now I will introduce our witness. 
We will hear from Dr. Rahul Gupta, the director of National 
Drug Control Strategy.
    The witness will be unmuted so we can swear him in. Please 
raise your right hand.
    Dr. Gupta? I don't see him up there. Is he on? Is he with 
us?
    Voice. He is just not speaking----
    Dr. Gupta. Madam Chair, I am on.
    Chairwoman Maloney. I see you now. Please raise your right 
hand.
    Do you swear or affirm that the testimony you are about to 
give is the truth, the whole truth, and nothing but the truth, 
so help you God?
    Dr. Gupta. I do.
    Chairwoman Maloney. Let the record show that the witness 
answered in the affirmative. Thank you.
    Without objection, your written statement will be made part 
of the record.
    With that Dr. Gupta, you are now recognized for your 
testimony.

  STATEMENT OF RAHUL GUPTA, DIRECTOR, OFFICE OF NATIONAL DRUG 
       CONTROL POLICY, EXECUTIVE OFFICE OF THE PRESIDENT

    Dr. Gupta. Chairwoman Maloney, Ranking Member Comer, and 
members of the committee, thank you for inviting me to testify 
about President Biden's inaugural National Drug Control 
Strategy.
    This Strategy was released in a time of unprecedented 
challenges. For far too many years the overdose crisis has been 
unraveling the very social fabric of our Nation and destroying 
American lives and livelihoods. The Centers for Disease Control 
and Prevention estimates that overdoses have claimed more than 
1 million lives over the past two decades. In 2021 alone, we 
lost more than 107,000 Americans. That is one life lost every 
five minutes. These are our friends, family members, co-
workers, and neighbors. Since 2015, overdose deaths in America 
have more than doubled, and the COVID-19 pandemic has amplified 
the existing difficulties in accessing treatment for substance 
use disorder.
    As a practicing physician for the last 25 years, I have 
treated many patients with addiction who have gone on to lead 
successful lives in recovery, but I have also seen too many 
patients succumb to their disease, and I have attended far too 
many funerals. Working in the emergency room, I have 
experienced weeks and months where I was reversing overdose 
every shift. Now, behind these overdoses, fatal overdoses, 
there are millions of individuals experiencing non-fatal 
overdoses that are overwhelming our first responders and the 
healthcare system. Underneath these overdoses are tens of 
millions of Americans suffering from substance use disorder. 
There are other effects as well. Research estimates that the 
economic cost of the epidemic to be a staggering $1 trillion a 
year, and up to 26 percent of the loss in U.S. labor force 
participation can be attributed to the disease of addiction.
    Now, addiction and the overdose epidemic is a nonpartisan 
issue, which is evidenced by the fact that it touches everyone, 
regardless of where you live or how you vote, and this is why 
ending the opioid epidemic is part of President Biden's unity 
agenda, and why it has strong support across the country and 
across political parties for finding comprehensive and 
meaningful solutions.
    As the Office of National Drug Control Policy developed 
this Strategy, we focused on the fact that this epidemic is 
being driven largely by untreated addiction and drug 
trafficking profits. This Strategy's seven goals focus on 
reducing substance use, overdose deaths, and the supply of 
illicit substances, and increasing prevention, harm reduction, 
treatment, and recovery efforts, and finally, improving the way 
the criminal justice system addresses substance use disorder so 
that people can get the help they need before it is too late.
    There are also four key priorities that cut across the 
Strategy. At a time when 3 out of 4 overdose deaths involve 
opioids, it is critical that we are making sure everyone can 
access naloxone. We are also working to ensure that everyone 
can get the treatment. We are disrupting drug trafficking 
operations. The United States has the fundamental 
responsibility to protect its borders, and this is precisely 
what the Biden administration is doing. And we are improving 
data collection, particularly for non-fatal overdoses, as they 
are a good indicator that someone will experience a future 
fatal overdose. Now, taken together, these goals and priorities 
usher in a new era of drug policy that is comprehensive, 
holistic, and targeted at saving lives first.
    At this moment in history, our Nation is at an inflection 
point. Our actions must rise to the occasion by being bold and 
innovative, but also compassionate and consequential. The 
Biden-Harris Administration's inaugural National Drug Control 
Strategy is an unprecedented evidence-based blueprint designed 
to save lives immediately, build the infrastructure for 
treating addiction our Nation so desperately needs, and 
disrupting drug trafficking and the profits that fuel it, all 
the while ensuring that the Federal Government is accountable 
and serves as a good steward of taxpayer dollars.
    Saving lives is our North Star because I believe that every 
life is precious and worth saving. If this Strategy is 
implemented as intended, we could be saving 164,000 lives over 
the next three years and help tens of millions of people get 
into treatment on the path to recovery. The President and I are 
committed to seeing this through because American lives depend 
on it.
    Thank you for your continued efforts to make our country 
safer, and as President Biden said, let us come together to 
beat this. I look forward to your questions.
    Chairwoman Maloney. The gentleman yields back.
    I now recognize myself for five minutes for questions.
    Thank you very much, Director Gupta, for coming before the 
committee today and for your leadership, and thank you for your 
tireless commitment to ending the overdose crisis which has 
devastated so many families in our country. I know that this 
has been a top priority of the Biden-Harris Administration 
since day one.
    Director Gupta, in addition to issuing this year's National 
Drug Control Strategy, what progress has the administration 
made so far in expanding access to services and care to prevent 
overdoses and treat addiction?
    Dr. Gupta. Thank you, Madam Chairwoman. We have had 
significant progress made. In fact, now there are telehealth 
provisions that allow providers to treat addiction across the 
country, especially in rural areas, underserved communities, 
and behind the walls. Telehealth, including phone consultation, 
is a crucial aspect of expanding treatment. We know that less 
than 1 out of 10 people today are getting the treatment that 
they need. DEA has mobile vans for methadone as well as take-
home methadone. These aspects are helping us improve and expand 
treatment at a time when oftentimes people are dying without 
treatment. We are also making efforts to make sure that 
everyone can get naloxone, which is the antidote for opioid 
overdose reversal, which 3 out of 4, almost 80,000 people are 
dying because of the lack of naloxone. At the same time, we are 
allowing more and more physicians, and providers, others to be 
able to write prescriptions through practice guideline changes 
so that they will have, able to get more treatment across.
    For our goal of treating untreated addiction, creating the 
infrastructure, the American Rescue Plan has invested $4 
billion, unprecedented amounts, and the President has now 
called for an increase in $3.2 billion. Seventy-five cents on 
the dollar of that increase of the $42 billion drug control 
budget goes toward making sure we are expanding treatment, we 
are expanding prevention, we are expanding recovery services.
    Chairwoman Maloney. The coronavirus pandemic strained every 
aspect of the American healthcare system with a 
disproportionate burden falling on people with addiction and 
the providers who treat them. One way the Federal governmment 
responded to this crisis was by promoting the use of telehealth 
to increase American access to addiction treatment. Dr. Gupta, 
does the administration support the continued use of telehealth 
flexibilities for addiction treatment beyond the coronavirus 
pandemic? Can you expand on how it is made available to people? 
How are they made aware that they can have this type of 
treatment?
    Dr. Gupta. Thank you, Chairwoman. It is extremely important 
for President Biden, for this administration to ensure that 
telehealth services are available and are made available beyond 
the public health emergency. My reason for that is that, 
especially people in rural areas, like my home state of West 
Virginia, who are often not able to drive, not able to take the 
effort to get where it needed because of the rurality, these 
telehealth services allow much more efforts to be provided to 
people. It is a time where we need to meet people where they 
are, and telehealth, including phone consultation, allows us to 
do just that. And same goes for people, especially in 
communities of color, who already have a difficult time and a 
delayed time accessing services. This is another service that 
will help us expand treatment.
    Chairwoman Maloney. OK. Last December I led nearly a 
hundred of my colleagues on the Democratic side in 
reintroducing the CARE Act, landmark legislation that would 
provide $125 billion in new Federal funding directly to 
communities and care providers, over 10 years to overcome the 
overdose crisis. Director Gupta, do you agree that we need to 
provide sustained comprehensive investments in treatment and 
care to communities at the frontlines of this crisis as our 
CARE Act would do? Why or why not?
    Dr. Gupta. Thank you, Chairwoman. It is one of the critical 
aspects of this particular crisis that we provide these types 
of services to folks, not just for treatment, but beyond 
treatment, to provide that support, a comprehensive support. 
So, it is important that we think about the ability to get 
people to help when they need it, where they need it, and 
efforts like this help us get there quicker and ultimately save 
lives.
    Chairwoman Maloney. Thank you. I commend the administration 
for its tireless work to overcome this crisis and reduce the 
harm it inflicts on our society, and I am a proud partner with 
you in this work, and you bring invaluable experience to the 
country from your work in West Virginia.
    I now call on Representative Norman.
    Mr. Norman. Thank you, Chairwoman Maloney, Doctor, and 
thank you for taking the time to come. Now, I was listening to 
your opening words. You said this, that the Biden 
administration had a top priority for protecting Americans, 
protecting the border. Did you say that? I mean, am I right, he 
is doing a great job of protecting the border?
    Dr. Gupta. Thank you, Congressman, for that question. We 
believe strongly that it is an important part of every Nation 
to be able to secure and protect its border. There are a number 
of things that are going on in this area of counternarcotics 
that I think is important to note. As I visit, I speak to the 
women and men on the border----
    Mr. Norman. No, no. Look, Doctor, I don't mean to 
interrupt. I got a limited amount of time. Is he taking the 
steps to close the border? Is that what I understand you to 
mean?
    Ms. Gupta. Congressman, thank you again. The President is 
certainly taking steps to make sure that our border remains 
secured, part of which is----
    Mr. Norman. Oh, my Lord. OK. Doctor, OK. This is two 
different universes. I assume you agree with the numbers of 
illegals coming across. We are going to average 585,000 a 
month. We are up to--what is this--1.6 apprehensions. Donald 
Trump with the wall had this solved. We have 50 during the 
three prior years. Those on the terror watch list were 
basically zilch. This past year is 50 on the terror watch list. 
How can you sit there and say that this administration has a 
goal of protecting Americans?
    I am in the construction business. We had a leak on one of 
our projects. You stop the leak in the pipe. We had a dam that 
had a leak in the dam for the water. You stop the leak. I mean, 
really, this is a mischaracterization at best. Either the 
numbers are completely false. We are getting a unprecedented 
number of people coming across. We already got 3 to 5 million 
illegals in this country, so I guess we don't want words, and 
we don't want hearings. We want action. All he has to do is 
build a wall and have a designated point of entry.
    How many times has the Vice President been to the border 
that you know of? She was supposed to be the big czar heading 
this up. How many times has she actually been to the border to 
see what is going on?
    Dr. Gupta. Congressman, I will leave that to the Vice 
President to answer. What I can tell you is I have been----
    Mr. Norman. Zero. Zero. She is giggling. She is laughing 
about it. How many times have you and your staff been to the 
border?
    Dr. Gupta. Yes, Congressman. Thank you for that question 
again. I, on my first week in office, I actually went to our 
Southwest border and I went to Mexico. Recently, last month, I 
went to the San Ysidro border in San Diego. The first one is El 
Paso. I was able to spend a considerable amount of time. And I 
will say that, as the ranking member mentioned, since last 
year, beginning, we have apprehended 600,000 pounds of illicit 
drugs, including 11,000 pounds of fentanyl. And I will tell you 
why that is important.
    Mr. Norman. No, that is because it is coming across 
unfettered, Doctor. I mean, they are unfettered. I mean, they 
are coming across. That is why the cartels are winning. They 
are making a billion dollars a month, and they are unfettered 
coming into this country. I am tired. The blood is on the hands 
of this administration for what he is doing. Our police 
officers are sick and tired of the danger they face on the 
streets today in South Carolina because of his inaction.
    And now, I tell you, this is one of the tragedies that is 
going to be hard to walk back. This administration will not 
take ownership, and to start touting things he has done, he has 
opened up this country, our sovereignty is at stake, and we are 
losing it. I know you are part of the administration, but it 
astounds me you are making these statements because it is just 
not true with the open borders that he is allowing to happen 
and endanger everybody in America.
    Dr. Gupta. Congressman, if I can complete my response. What 
I was saying is that that amount of drugs is not in our 
communities killing Americans right now. The proceeds, up to 
$16 billion, and we are denying those to the transnational 
criminal organizations that are often used for crime for 
corruption and other events in the host countries that often 
destabilize fragile democracy and become the cause of migration 
in the first place. So, I am proud of the work that our men and 
women are doing at the border, but I also want to mention this 
problem doesn't start or end at the border. It starts with 
precursor shipments in China and ends up as overdose and fatal 
overdoses in our communities. We have----
    Mr. Norman. Doctor, how many countries are we----
    Chairwoman Maloney. The gentleman's time has expired. We 
could have a second round, but we have to keep moving.
    Congresswoman Norton, you are now recognized.
    Ms. Norton. Thank you very much, Chair Maloney. Dr. Gupta, 
let me preface my questions by noting that I am extremely 
disappointed that the Biden administration's two budgets have 
proposed maintaining the right that prohibits the District of 
Columbia from spending its local funds on commercializing 
recreational marijuana. I will be submitting a question for the 
record on this matter.
    Ms. Norton. With that said, since assuming office, the 
Biden administration has shown a robust commitment to advancing 
equity and centering recovery over punishment in our Federal 
response to the overdose crisis. In 2022, the National Drug 
Control Strategy clarified further this crucial commitment. Dr. 
Gupta, could you explain the racial disparities that currently 
exist in incarceration and arrests for drug-related offenses? 
And how have these incarceration disparities perpetuated 
inequities in the ways communities experience the drug overdose 
crisis?
    Dr. Gupta. Thank you, Congresswoman. It is no doubt that 
the disparities in incarceration that exists and continue to 
exist have perpetuated a lot of challenges. I would say the 
question in the matter of D.C. rider, I understand it is with 
Congress, and I will leave it at that. And having said that, 
the President has been very clear that he supports decisions 
regarding legalization of marijuana up to individual states, 
but at the Federal level, he has supported decriminalization of 
marijuana use and automatically expungement of records. And 
part of the reason is because of the disparities in 
incarceration.
    Now, one of the things we are doing through the Strategy is 
looking at all of the metrics that are available to us and 
where the data makes sense, for example, pre-arrest diversions. 
We were able to put forward a state model on deflection. 
Deflection is the idea that for nonviolent crimes, if someone 
has a mental health disorder or addiction, let's get the person 
the help. Let's get them the treatment. Let's get them figured 
out housing. Let's get them other things instead of 
incarcerating them. It is not only a good thing to do, prevents 
recidivism, but it is also cost-effective for the communities. 
It is these type of things that the Strategy looks at. It is 
figuring out how to solve problems at a community level and 
making sure that we are doing that with equity with the lens of 
equity at it.
    Ms. Norton. Thank you. To address the inequities in our 
criminal justice system, the Strategy urges the Department of 
Justice to identify opportunities to amend Federal statutes 
requiring mandatory minimums for drug-related offenses, and it 
calls for greater intergovernmental collaboration to address 
the root causes. How will these steps advance racial equity in 
our Federal response to the overdose crisis?
    Dr. Gupta. Thank you, Congresswoman. You know, as a 
physician who practiced for 25 years, I have seen the effect 
not just for individuals but also the family, the 
neighborhoods, the community. So, it is important for the 
administration to make sure that we are looking at every option 
and every possible way to have both judicial independence, and, 
at the same time, figure out what is the best way forward in 
ensuring that we are addressing equity at the same time we are 
addressing the drug crisis that is happening.
    So, it is important for us, as I mentioned, to look at the 
alternatives. That includes drug courts. That includes making 
sure that people have this help while incarcerated. We know 
that 2 out of 3 people behind the walls have a substance use 
disorder or addiction. It is important for us to make sure that 
people are getting the treatment, both behind the walls but 
also upon reentry. And the reason for that is that is a 
commonsense smart way to not only save lives, but also save 
money and have more productive communities. As I mentioned, up 
to 25 percent, 26 percent of the labor force participation loss 
has been because of addiction, and we need to change that. And 
looking at it through the lens of equity is an important piece 
of doing that.
    Ms. Norton. The 2022 National Drug Control Strategy 
proposes steps for the Federal Government to better understand 
these racial inequities across our criminal justice system. It 
calls for universal substance use disorder screening for people 
who are arrested. How will these steps help to ensure that 
people in incarcerated settings have access they need to treat 
addiction? And why is this such an important component of the 
fight against addiction----
    Chairwoman Maloney. The gentlelady's time has expired. The 
gentleman may answer her question.
    Dr. Gupta. Thank you. This allows us to provide access to 
treatment behind the walls. The Federal Government is already 
working on that for Federal prisons because we want to walk the 
talk, we want to make sure that we are leading. So, we are 
currently working with Bureau of Prisons, Department of 
Justice, DEA, and HHS to make sure that we could provide 
treatment behind the walls so we can have productive 
communities at reentry.
    Chairwoman Maloney. Representative Cloud, you are now 
recognized.
    Ms. Foxx. Madam Chair, this is Virginia Foxx. I think I am 
on next.
    Chairwoman Maloney. Oh, we would----
    Mr. Cloud. That is fine with me. She can go first.
    Ms. Foxx. Thank you, Michael. Thank you, Madam Chair. Dr. 
Gupta, it is interesting to me you say, ``behind the walls.'' 
It is impossible for you to say, ``people in prison,'' I guess. 
Dr. Gupta, what percentage of drugs coming across the Southern 
border are fentanyl or laced with fentanyl?
    Dr. Gupta. I can speak about the seizures. I do not have 
direct data on the amount or percentage of the seizures.
    Ms. Foxx. OK. Well, of the seizures.
    Dr. Gupta. Of the seizures, the volume of it, because most 
of those seizures----
    Ms. Foxx. No, just what percentage are fentanyl or laced 
with fentanyl?
    Dr. Gupta. I can get you that data, Congresswoman.
    Ms. Foxx. OK. I think it is most of them. Since fentanyl is 
one of the most deadliest drugs that is coming across the 
Southern border, what policies has this administration 
implemented to stop it, and I would just like you to say one, 
two, three, four, policies. Don't go into extraneous 
information, please.
    Dr. Gupta. Yes, Congresswoman. So, first of all, there is a 
United States-Mexico Bicentennial Framework that is looking at 
particular policies that fuel the trafficking, that fuel the 
transfer across the border, and work with Mexico as a partner 
to make sure that, we are working on that. The second, 
President signed an executive order that expands the 
prosecution and placing of sanctions to not just individual 
traffickers, but also the enablers, their financiers, and I can 
provide details later on to you for that.
    Ms. Foxx. OK. And the first thing you gave nothing. There 
is nothing in what you said. It is a working on an agreement, 
so nothing there. You are saying just one thing, and I will 
look for the details. So, during the Trump administration, we 
saw the first annual decrease in overdose deaths in 30 years, 
with the Trump DHS setting an all-time high for the amount of 
drugs seized at the border, and the Trump administration 
awarded a record amount of Federal grants in support of drug 
interdiction and public health programs. What can we do to 
replicate this kind of success moving forward, and why hasn't 
the Biden administration already kept those programs in place?
    Dr. Gupta. Thank you, Congresswoman. I was Virginia health 
commissioner at the time, and I can tell you that during 2018, 
the deaths from fentanyl actually went up by 10 percent, so the 
decrease was not, unfortunately, in fentanyl during that time. 
What we have seen now, two weeks ago, CDC provided its first 
12-month numbers, that have shown a few hundred decline in the 
deaths for a 12-month period from month to month. We are now--
--
    Mr. Foxx. OK. Well, let us have that information. We would 
like to be able to compare what happened during the Trump 
administration with what is happening because that is not what 
we understand. The Trump administration's stance on securing 
the Southern border helped make America safer, stopped the flow 
of opioids into the Nation, and reduced overdose deaths, but 
the Biden administration's stance on the border is making us 
less safe and allowing opioid overdose deaths to continue 
increasing, despite what you are saying. So, without addressing 
our Southern border security, we simply cannot stop the flow of 
fentanyl into the country.
    According to the CDC, in 2021, more than 107,000 people 
died from drug overdose, up from 91,799 in 2020. Why has the 
Biden administration failed to bring down drug overdose deaths?
    Dr. Gupta. Thank you, Congresswoman. I believe we are 
seeing now a blunting of the curve of overdose death. We know 
there are multiple factors. We also know that it is very 
important to secure our border and continue to secure our 
border. That is exactly why President Biden has proposed a 
budget of increase of $300 million for Customs and Border 
Protection, for the drug budget. It is really important that we 
provide the men and women on the border in uniform the 
resources, the technology, as well as the infrastructure that 
they need to do the job that they are supposed to do.
    Mr. Foxx. Oh, come on Mr. Gupta. You can't believe that. 
Let me ask you one more question. As a physician who served in 
rural communities, like many throughout my district, can you 
describe what should be done to protect rural communities from 
fentanyl and other dangerous opioids?
    Dr. Gupta. Thank you, Congresswoman. I think, first of all, 
we got to get naloxone out there. We can prevent about 80,000 
deaths, a majority, if we can get naloxone out there, then 
connect people to treatment. We also need to have robust law 
enforcement drug trafficking efforts to make sure that we are 
cutting into the profits. That is where the High Intensity Drug 
Trafficking Area, or HIDTA, programs are important because they 
bring in local state and Federal partners to work collectively, 
and they are doing a great job of interdicting that supply 
right now. It is a combination of both, public health and 
public safety, especially in rural communities.
    Ms. Foxx. You seem to know what to do, but you are not 
doing it. Thank you, Madam Chair. I yield, expired.
    Chairwoman Maloney. The time has expired. Representative 
Lynch, you are now recognized. Representative Lynch.
    Mr. Lynch. Thank you, Madam Chair, and, Dr. Gupta, thank 
you for joining us, and thank you for all your good work.
    You know, I have been at this a while, and we have had a 
difficult time in addressing the drug problem in this country. 
We seem to have gone from a policy where we tried to get people 
clean and sober to a policy where we now try to get them off 
one drug and put them on another drug. And I am speaking 
specifically about suboxone and how we have taken the lid off, 
and allowed doctors to have hundreds of patients and just give 
them suboxone and not really deliver any behavioral health 
services that would get at the underlying addictive activity. 
And I am seeing it in my district where we have got a couple of 
clinics that hand out suboxone. The patients go out the door, 
and then they either trade that or they buy fentanyl or 
methamphetamines, which is even a worse problem. They can't get 
high with the suboxone, so they are going to harder drugs, and 
we are actually seeing much more violent activity because an 
individual on methamphetamines might be up for days, and we are 
seeing a lot of stabbings, a lot of violence.
    And I am just questioning the whole policy here where we 
seem to be moving away from, you know, getting people straight, 
getting them clean, getting them sober, getting them back into 
their lives, and instead we are getting them on different 
drugs, and I just don't see a good result as a result of that 
policy. You got any thoughts on that?
    Dr. Gupta. Thank you, Congressman. You know, one of the 
things we have realized in the last few decades is this is a 
brain disease. It is just like a lot of other diseases. It is a 
brain disease, and the way we need to treat that is as a 
disease of the brain. That includes making sure that we 
understand the disease better, we provide the FDA-approved 
medications to help the person. And people may have different 
ways of getting at the treatment, Congressman. Some people may 
actually do OK, cold turkey. Others may actually need the 
medication for varying amounts of time.
    But one thing that I have in my 25 years learned is we got 
to figure out how to get the help to people when they need it 
and where they need it because they may not be coming back. The 
next time they come back would be as a fatal overdose in my 
emergency room, and that is why we have taken effects and 
actions here to save lives first. And part of that means to get 
people the help they need, figure out what works for them while 
not giving up on our research agenda, making sure that we are 
looking----
    Mr. Lynch. I appreciate that, Doctor, I really do, but I am 
just telling you. I am trying to give you a little feedback. It 
is not working where I am. It is not working in the 8th 
congressional District of Massachusetts. I got 10 cities. I got 
hundreds and hundreds and hundreds of people all together right 
next to the suboxone clinic, right next to the methadone clinic 
that are shooting up. And, you know, they are shooting up 5 or 
6 times a day and, you know, it is just a very bad situation. I 
have had to go down there and look for young people who have 
left their families and are now totally off the grid and 
addicted, you know, to fentanyl and methamphetamines, and it is 
a sad, sad state.
    You know, The Journal of Medicine just came out with an 
article last week, two weeks ago, that in one year, between 
2019 to 2020, the adolescent death rate has gone up 100 
percent, double in one year. And, you know, I just think that 
we are pushing more of this stuff out. It is not helping, so I 
think we have got to reassess.
    One last question. You know, I am also on the 
Transportation Committee, and I had an unclassified briefing 
with the Department of Homeland Security and FAA, and this was 
on Judicial Watch as well. We had 9,000 unauthorized drone 
incursions over the Southwest border last year--9,000. And I am 
just wondering, you know, these drones have a payload of 
anywhere from 3, to 5, to 8 pounds, and I am sure a lot of 
fentanyl is coming in over the border by drone. Not by 
individuals, but by drones. They are shipping it in. And I am 
just wondering, I know the number of interdictions has 
increased, but I am just worried about volume. Is that because 
there is more volume coming over? Do you have any thoughts on 
that?
    Dr. Gupta. Thank you, Congressman.
    Chairwoman Maloney.--expired, but the doctor may answer 
your question.
    Dr. Gupta. Thank you. On the first part, I would say it is 
tragic, Congressman, and we are willing to work with you and 
Congress in any way possible we can help Americans, too many 
dying, unacceptable. On the second part, that is exactly the 
challenge today. The 21st century tools and technology that we 
need to be a deterrent to these air drone, marine drones, 
subterranean tunnel, some of which I have been inside of, we 
are going to need to work collectively to have deterrence 
technologies of the future because our adversaries are not 
waiting on us to develop them to fight this. And so I would 
look forward to working with Congress on some of those aspects 
which the bad guys figure out one way or the other to bring 
drugs in----
    Mr. Lynch. I look forward to working with you as well. 
Thank you, Madam Chair. I yield back.
    Chairwoman Maloney. The gentleman yields back.
    Representative Cloud, you are now recognized.
    Mr. Cloud. Thank you, Madam Chair, and thank you for being 
here, Dr. Gupta. I have a few very quick questions for you. 
That should be pretty easy. How many fentanyl deaths have there 
been in the last year?
    Dr. Gupta. About 80,000. That is----
    Mr. Cloud. About 80,000, and we know the majority----
    Dr. Gupta. That is opioids, including fentanyl, sir.
    Mr. Cloud. Yes, we know the majority of that is coming over 
the Southern border. You already touched on a little bit, but 
where is most of the fentanyl coming from? Where are the 
cartels sourcing it from, either the fentanyl or components to 
make it?
    Dr. Gupta. Predominantly China, some amount----
    Mr. Cloud. Predominantly China, yes. And if China were to 
send over some sort of bomb, chemical warfare that killed 
70,000, 80,000, to 100,000 people in our country, do you think 
that would be considered an act of war?
    Dr. Gupta. Congressman, I think we are already trying to 
make sure that China understands the importance and 
significance of cooperation in this area, but certain----
    Mr. Cloud. If they had sent that many people over with guns 
that killed 70,000, 80,000 people, do you think that would be 
considered an invasion?
    Dr. Gupta. Congressman, clearly people are dying already 
from fentanyl, of course.
    Mr. Cloud. Yes. In the few years that I have been in 
office, we have gone from the coyotes on the Southern side of 
the border who kind of duck and hide until our armed border 
patrol would move their posts, and then they would try to sneak 
people and drugs across, to now the coyotes are armed sometimes 
better than our Border Patrol agents, and our Border Patrol 
agents have been told to stand down. And so now the cartels, 
armed, bring their loads to our cartel members and tell them to 
get them to the station for processing. This is a completely 
backward approach to border security.
    And the chair at the beginning of this hearing tried to 
make some benefit and make it sound good that we are catching 
more fentanyl at the border. That is a ridiculous notion and a 
spin on some really, really bad news. We are catching more 
because there is more coming across, not because we are 
catching more of a percentage of what is coming across. There 
is almost a half million got-aways coming across our border 
that are suspected undetected got-aways, not to mention the 
people who we know that we are not catching that are coming 
across, and the cartels are wreaking havoc on our Nation while 
this Nation stands down.
    Now you are wanting more money from us to fix this issue, 
but my question for you is we have already sent you money to 
secure the border, the Biden administration. How do we know 
that if we send you money for anything, you are going to use it 
for what you are legally obligated to use it for?
    Dr. Gupta. Thank you, Congressman.
    Mr. Cloud. Why should we as Congress trust the Biden 
administration at this point?
    Dr. Gupta. Thank you, Congressman. I think when I go down 
and I talk to individual agents as well as leaders of the 
Customs and Border Protection, as well as the other Federal 
agencies, look at the technology that is there that can be 
enhanced, I look at the infrastructure, the people, the 
resources that could be enhanced, all of our deterrent and 
detection technologies that can be enhanced, I think that is 
the rationale to making sure. I can tell you that----
    Mr. Cloud. We have already paid in Congress. We have 
already authorized and paid for much more border infrastructure 
and technology to be put in place. And the Biden administration 
continues to pay more than what it costs to put the wall up 
than to keep it down, and manned, and guarded, and rusting away 
in a stockpile. So, we could be doing a lot more to stop the 
cartel activity coming across the border. We are turning Mexico 
into a narco-state because of our inaction on the border, and 
they are beginning to have even footholds and even take over 
communities in the United States of America. I don't understand 
how the Biden administration makes any sort of positive news 
out of this.
    Dr. Gupta. Congressman, I went to the wall in San Ysidro, 
and then I walked 10 meters back to United States. And I went 
down several feet into a tunnel, a drug smuggling tunnel that 
was coming from across the border. There are hundreds of those. 
Women and men of the Border Patrol and Customs and Border 
Protection are working to seize and provide mitigation to those 
tunnels. We need cooperation from the Mexicans to do that on 
their end, but the fact is that it is----
    Mr. Cloud. Well, tunnels is one aspect, but they are coming 
in drones, but the wall that we have already paid, that the 
administration is breaking the wall and not to build, we have 
already paid for it. We have given the direction to do it. 
Their job is to execute the laws of the land, and they are not 
executing, so there is no way around that. They need to execute 
the laws of the land as sworn to do, as you had sworn to do, as 
Biden is sworn to do, as Kamala Harris is sworn to do.
    So, I am going to move on to Big Tech for a little while. I 
am curious to know what you have done. A lot of this is being 
bought by young people over TikTok. Cartels are even recruiting 
over TikTok to make transports and those sorts of things in 
social media as well. The Big Tech and social media company has 
been pretty effective at clamping down on ideologies that they 
don't like to be particularly conservative ideologies. What 
kind of communication have you had with Big Tech when it comes 
to getting them to just allow cartel activity on their 
platforms?
    Dr. Gupta. Thank you, Congressman. We have had several 
conversations with Big Tech companies. We are working here at 
the office, particularly with one large one, where also CDC is 
working to make sure that there are PSAs, that Big Tech is 
taking its own accountability in place. DEA is, as well, 
providing the One Pill Can Kill Campaign through a variety of 
mechanisms, including social media, and clearly there is more 
that we need to do. Why? Because we still have kids oftentimes, 
but others as well, who do not often understand the importance 
of counterfeit pills these days, but the conversation and the 
work is ongoing. I have been personally engaged and involved in 
some of those conversations and actions.
    Mr. Cloud. Thank you, Chair. My time is up. I yield back.
    Chairwoman Maloney.--time has expired.
    Representative Raskin, you are now recognized.
    Mr. Raskin. Thank you, Madam Chair. Dr. Gupta, addiction is 
a terrible brain disease as you have described it, and I 
believe the administration has adopted an approach called harm 
reduction of trying to help people recover from addiction and 
trying to reduce the other lethal harms of the terrible traffic 
in addictive drugs. Can you explain what is the overall theory 
behind harm reduction, and what are the components of it, and 
how well is it working now?
    Dr. Gupta. Thank you, Congressman. Over my 25 years, what I 
have seen oftentimes is, or the only time I will see somebody 
is when they are dead in my emergency room. I will often see 
them auto reversing and they go away. The fact is that where 
people are utilizing drugs, where they are using, we are not 
there. And where we are, four walls of the doctor's office, 
hospital, they are not there because there is a lack of trust. 
There is a lack of understanding, and the idea behind harm 
reduction is to meet people where they are, engage them, and 
build trust. And ultimately, what studies have shown is these 
types of strategies allows more people to enter into treatment, 
it allows more people to be saved, meaning in terms of saving 
the life, and it is cost effective.
    The administration is embracing proven strategies like 
naloxone, the antidote, making sure people get them antidote 
for opioid overdose. Because we talk about counterfeit drugs 
that are out there in the community now, we are looking at how 
do we get people to help be able to check their own drugs to 
make sure that they are not playing Russian roulette each time 
they are using those drugs. And last, the Syringe Service 
Program that help us prevent the spread of dangerous, fatal, 
and very expensive, lifelong diseases like HIV and hepatitis. 
We have gone through a pandemic. We know what an epidemic or 
outbreak of HIV and hepatitis looks like, and it is a proven 
strategy to prevent that from happening. Those are the three 
aspects that were in the Strategy mentioned with the goal of 
making sure we are saving lives, first and foremost, and then 
obviously engaging individuals.
    Mr. Raskin. OK. And is that a policy that most of the 
states and local governments are participating in along with 
the Federal Government?
    Dr. Gupta. Yes, Congressman, it has bipartisan support, and 
it is one that has been adopted by many state and local 
governments and have, as a result, saved lives.
    Mr. Raskin. Well, how do you envision the role of the 
national government going forward in expanding access to harm 
reduction services? Obviously, we are in the thick of this 
terrible crisis, and our people are suffering, and more and 
more people are getting addicted. So, how can the Federal 
Government become an instrument of actually getting assistance 
to our people who need it?
    Dr. Gupta. Thank you, Congressman. Harm reduction policies, 
as me, as a provider and a local health physician, I can tell 
you is all about building community trust, bringing all 
partners together, including law enforcement, to build that 
trust. The Federal Government can certainly, and Congress can, 
of course, provide the resources that are needed for 
communities to be able to, on a voluntary basis, if they want 
to, pursue these, but also the ability to heal the community 
through building trust, through connecting people back with 
treatment and the offering resources that they need to move 
forward. We have too many broken communities across the Nation 
because of this crisis, and this is another opportunity to do 
that, just that, with the resources, of course from Congress.
    Mr. Raskin. OK. Thank you. I will yield back to you, Madam 
Chair.
    Chairwoman Maloney. The gentleman yields back.
    Mr. Grothman, you are now recognized.
    Mr. Grothman. Thank you. Can you hear me? Mr. Gupta, the 
statistics I am looking at show that two Aprils ago, April 
2020, 6,000 people crossed the border and were let in the 
country. Most recent April, we are at 183,000. So far, from 
6,000 in April to 183,000. Do you feel that that is a complete 
and total embarrassment? How would you describe that 
performance as far as its effect on what we are discussing 
today, 6,000 to 183,000.
    Dr. Gupta. Thank you, Congressman. I am having a little bit 
difficulty hearing you. I believe you were comparing numbers.
    Mr. Grothman. OK. We will say 6,000 people crossed the 
border and were let in the United States in April 2020. The 
most recent April number was 183,000, so we have gone from 
6,000 to 183,000. Do you consider that a complete 
embarrassment? And do you think we have to do something to get 
back the policy that went up to 6,000 if we are going to reduce 
the amount of illegal drugs flowing into this country?
    Dr. Gupta. Thank you, Congressman. I believe, obviously, at 
ONDCP we are concerned about the amount of obviously fentanyl 
and other drugs that are trafficked across the Nation, but 
globally. And one of the things that I think is really 
important for us and for us to not lose sight of is where are 
these drugs coming from, how are they being manufactured, and 
obviously what is happening to the American people falling 
victim to these poisonous----
    Mr. Grothman. Do you care at all? Six thousand to 183,000, 
does that bother you?
    Dr. Gupta. Congressman, clearly it is important that we 
have a robust border. And I do believe that, to the extent our 
men and women are doing their job, they are doing their job, 
and we need to provide them the resources that they need.
    Mr. Grothman. Would you prefer to go back to the system or 
the rules under which they operated two years ago when they had 
6,000 people crossing instead of 183,000?
    Dr. Gupta. Frankly, Congressman, I would prefer to go back 
to a place where we didn't have literally any overdose deaths, 
and the fact is that we have too many overdose deaths. Over a 
million Americans have died, and we have got----
    Mr. Grothman. OK. I will give you another question if you 
don't want to answer that one. Given the huge number of deaths, 
the 110,000 from illegal drugs, 12-month period, do you feel 
more people than now should be put in prison for selling or 
trafficking these drugs in general and fentanyl in particular?
    Dr. Gupta. Congressman, I believe that people who are 
trafficking, manufacturing, and routing these drugs for the 
sole purpose of profits need to be held accountable, and they 
are our rule of law. No doubt about that.
    Mr. Grothman. Right now, you were hearing 10,000. Do you 
feel more people should be going to prison for trafficking or 
selling fentanyl and all?
    Dr. Gupta. I feel that people should be accountable for 
their actions. Of course we have the most lethal drug supply we 
have ever had in this Nation's history.
    Mr. Grothman. Right. If we had to do last year over, do you 
feel more people should be going to prison than now for the 
10,000 deaths?
    Dr. Gupta. Congressman, I think the responsible people 
should be----
    Mr. Grothman. OK, you don't want to answer the question. 
Next question. Do you know what the total number of 
professionals dealing with addiction and that sort of thing has 
been, say, this year compared to 10 years ago when the problem 
was not as bad? Could you give an estimate of the number of 
people making their living as addiction professionals?
    Dr. Gupta. Congressman, I can tell you we have significant 
shortage of professionals for addiction medicine that----
    Mr. Grothman. That wasn't the question. Can you just do me 
a favor and answer one of my questions? Do you know the total 
number of people working in this field today compared to, say, 
10 years ago?
    Dr. Gupta. I can get the figures for you, Congressman. I do 
know we have significant shortages, but I can get you exact 
numbers.
    Mr. Grothman. OK.
    Dr. Gupta. We have had significant turnover during the 
pandemic as well, so that would be----
    Mr. Grothman. OK. Now, the next question. I know people who 
have been stuck in this addiction from all sorts of family 
background. Nevertheless, I feel there are all sorts of 
problems in our country that correspond to the decrease in 
family backup. Do you have a statistics on either people who 
die or people who are convicted for selling these drugs as to 
their family background, or does anybody have those statistics?
    Dr. Gupta. Of family background, Congressman?
    Mr. Grothman. Correct. You know, what type of family 
structure, family structure? You know, they have no father at 
home, or they have mom and dad at home, they have no parents at 
home. Does anybody collect those statistics?
    Chairwoman Maloney. The gentleman's time has expired. The 
gentleman's time has expired.
    Representative Kelly, you are now recognized.
    Ms. Kelly. Thank you, Madam Chair. The Biden administration 
is committed to a health equity approach to addressing 
substance use disorders and recognizes that, for far too long, 
people have been unable to obtain treatment simply because they 
experience low income or because they live in a community 
lacking adequate recovery resources. President Biden's National 
Drug Control Strategy aims to address the systemic health 
disparities that previous administrations have frankly ignored. 
Director Gupta, I understand that there is a link between 
unemployment or experiencing low income and substance use 
disorders. How has the administration been addressing this and 
other root causes?
    Dr. Gupta. Thank you, Congresswoman. I think one of the 
aspects that this strategy looks at is the underlying factors, 
and it is important for us to understand the childhood 
experiences matter. We call them adverse childhood event, and 
experiences, and ACEs. It is important that we know from this 
data that somebody who has these types of events, five or more, 
has almost tenfold increased risk of using illicit drugs, also, 
overall, lack of education, less likely to have or hold a job. 
So, these things are all connected. But when we look at the 
underlying factors, we look at things like housing, things like 
job, economic security, food security, all of those aspects are 
important to a person's not just survival, but also thriving. 
So, it is important for us as we work with other agencies, like 
HUD, or Transportation, or others, to make sure that we are 
looking at the entirety of the picture of communities and 
addressing it from that perspective as well.
    Ms. Kelly. Yes. I was going to ask, how does the 
administration plan to utilize prevention methods to 
specifically address the social determinants of health?
    Dr. Gupta. Thank you, Congresswoman. One of the things that 
we want to be able to do, as the President's HUD announcement 
and President has taken a leadership on this, which is to make 
sure that people have the housing needs that they need. 
Especially in the area of substance use disorders, it is 
critical, and that same thing goes for food security. It goes 
for economics. It also goes, as I mentioned, for deflection, to 
get people to help instead of incarcerating them. Those aspects 
that are part of the Strategy allow us to build a more 
resilient population, and actually, while making sure we are 
focusing on primary prevention for school-aged children as well 
so we can have a more robust future America which is really 
important part of this Strategy.
    Ms. Kelly. I know you have only been around not even quite 
two years, but any improvements or any consequences of your 
work already in ensuring equity when addressing treatment for 
opioid use disorder? Have you seen any pattern changes by using 
your strategies?
    Dr. Gupta. As I mentioned, two weeks ago, CDC for the first 
time demonstrated a 12-month pattern with fewer deaths than the 
past, report a month ago. This is a very small amount of 
change. We are hoping and expecting that as we continue this 
effort, it will have more. We are also making sure we are 
working with Department of Education to have information 
disseminated to school districts around prevention messages as 
well.
    The President is committed to ensuring that equity is 
something that we are looking at carefully, because we are 
seeing for the first time some of the highest rises in overdose 
deaths in African American population, especially black males. 
The worst problem is that we also know some populations have 
the most difficulty entering treatment. So, we are trying to 
narrow those two gaps to make sure that we are, at the end of 
the day, saving lives.
    Ms. Kelly. Thank you. And is further research and 
methodologies surrounding the social determinants of health and 
substance use something the administration is prioritizing?
    Dr. Gupta. Yes, Congresswoman, it is something that we are 
making sure that we are looking into the research, not just to 
what is, but what are those differences, how can we make it 
better, how can we also look at treatments and prevention 
aspects that could help us get to a place where fewer Americans 
are using drugs, but fewer Americans are ultimately dying.
    Ms. Kelly. Thank you so much. I just want to say we cannot 
fully address substance use disorder without first addressing 
its root causes and ensuring that marginalized communities 
receive the support they need. And with that, thank you, and I 
yield back.
    Chairwoman Maloney. The gentlelady yields back.
    Representative Biggs, you are now recognized.
    Mr. Biggs. Thank you, Madam Chair. Dr. Gupta, thanks for 
being here. Last month during a traffic stop, police in Pinal 
County, which is not a border county, but it is in my state, 
stopped two women for speeding. They found 500,000 fentanyl 
pills. Last month, 500,000. Synthetic opioid deaths, including 
fentanyl, up 23 percent from last year. Cocaine deaths, up 23 
percent from last year. Meth and other stimulants, up 34 
percent from last year. In Arizona, in a two-month period, the 
end of last year, seized more than 3 million fentanyl pills. 
And, Madam Chair, I ask that this article be put into the 
record.
    Chairwoman Maloney. Without objection.
    Mr. Biggs. Thank you. Thank you so much. And also, Dr. 
Gupta, just two weeks ago at Calexico, at the POA there, they 
found 55 pounds of fentanyl stuffed into a gas tank coming 
across the border, so, hallelujah, they are stopping some. Here 
is the score: 2018, Pinal County zero fentanyl pills; 2019, 700 
fentanyl pills, 2018-2019; 2020, 200,000-plus fentanyl pills; 
and then in 2021, more than 1.1 million fentanyl pills in that 
county alone. Dr. Gupta, in your written testimony you state 
the United States has a fundamental responsibility to protect 
its borders and this is precisely what the Biden administration 
has been doing. Just two months ago on the Judiciary Committee, 
Secretary Mayorkas testified that the Biden administration had 
operational control over the border.
    Dr. Gupta, are you familiar with the Secure Fence Act of 
2006?
    Dr. Gupta. I am aware of it.
    Mr. Biggs. So, here is how they define operational control: 
``the prevention of all unlawful U.S. entries, including 
entries by terrorists other unlawful aliens and instruments of 
terrorism, narcotics, and other contraband.'' You wouldn't say 
that our border is operationally secure knowing the amount of 
narcotics that are coming across, would you?
    Dr. Gupta. Well, Congressman, what I would say that our 
border is secure, but there is a lot more we can do.
    Mr. Biggs. You are saying the border is secure. OK. Well, 
see, that kind of undermines the credibility, so let me let me 
go through this. You say approximately 92 percent of the heroin 
seized and tested in the U.S. is from Mexico. Ninety-two 
percent of the drug that is killing Americans is smuggled over 
our Southern border. That is not operational control. So, let 
us go through just a little bit more. According to the DEA, 42 
percent of pills tested for fentanyl contained at least 2 
milligrams of fentanyl, which is considered a lethal dose. In 
the eight Texas ports of entry, they saw over a 1,000-percent 
increase in seized fentanyl.
    But here is the deal. You said that that is a great sign, 
and it is good, we are stopping some of it. But Brandon Judd, 
who is the president of National Border Patrol Council, 
testified under oath this year that CBP is lucky if they seize 
even five percent of what is coming over the border. You 
understand what I am saying, right? The ratio indicates that we 
are failing in interdicting drugs, and yet you are telling us 
that the border is secure.
    And you said that you have visited the border in two places 
San Ysidro and El Paso. I would love for you to come with me. 
Just you and me, incognito. We don't tell them I am a 
Congressman. We don't tell them that you are the director of 
the National Drug Control Policy. We won't tell them that. Just 
you and me, come on down. We will go to the border. I will take 
you to places where you can watch what is happening. You can 
watch our men and women of CBP overrun. So, there are literally 
hundreds of miles unprotected, which is where drugs are coming 
in. We will find a place. We will watch people come across in 
camo, carpet shoes, backpacks on, carrying drugs. I am happy to 
do that with you.
    And when you say we want to do $300 million to get 
interdiction materials, and you want to make sure you have high 
tech and you want to have all of that, fantastic, but you know 
what? When you talk to Border Patrol agents, and if you come 
with me, we will talk to real Border Patrol agents and even 
managers who will tell you, if they don't know who you are, and 
they know they can trust you, they will tell you what is going 
on. And they will say, look, we may need more resources, but 
you know what we really need? We need the policy so we can 
enforce the law to secure our border.
    And as long as we fail to do it, then we will continue this 
rather inhumane approach to the borders where you have drug 
trafficking, you have human smuggling, you have human 
trafficking coming across. You have people like the lady who 
was wandering around in the desert, found by some sheriffs' 
deputies just about a month, actually about two months ago now. 
Why are you carrying those pills? What are those pills? They 
are morning-after pills because I knew I would be raped 
repeatedly coming across.
    Dr. Gupta, it is incumbent upon you before you can solve 
the problem that you are trying to solve, and I appreciate you 
are trying to take a full-on multifaceted approach. It is a 
huge task. I don't envy you the task. But as long as you are in 
denial on what is happening on the border, you are not going to 
solve the biggest part of this, and that is the smuggling that 
is coming across. So Dr. Gupta, I do extend to you an 
invitation to come with me down to the border. I go often. I go 
to a lot of places, and I would love to have you there with me. 
And with that I yield back. Thank you, Madam Chair.
    Chairwoman Maloney. Representative Wasserman Schultz, you 
are now recognized.
    Ms. Wasserman Schultz. Thank you, Madam Chair, and thank 
you, Director, for your testimony and to the work of your 
office, as well as the Biden-Harris Administration's effort to 
combat this crisis. And let me just state to the record that 
your efforts are the furthest thing from not understanding what 
the crisis is. And in my experience with you and the 
conversations I have had with you, it is very clear to me that 
you understand the depth of the crisis, and also clear to me 
that immigration policy and border policy is not in your job 
description.
    So, our colleagues on the other side of the aisle in this 
committee talk a lot, a good game about focusing on what we are 
actually responsible for. That policy is not what we are 
responsible for in the Oversight Committee. But I do want to 
talk about an issue that directly affects my home state of 
Florida, and any of the deadly dozen states that haven't 
expanded Medicaid, how inadequate health insurance coverage 
contributes to our Nation's addiction and overdose crisis. 
Research shows that overdose rates are lower in states that 
expanded Medicaid coverage under the Affordable Care Act. In 
fact, states that expanded Medicaid coverage experienced at 
least 10-percent fewer overdoses involving synthetic opioids 
like fentanyl, and 11 percent fewer overdoses involving heroin 
when compared against states that haven't expanded Medicaid.
    So Director Gupta, how would further Medicaid expansion 
combat the opioid epidemic and improve access to treatment and 
recovery for individuals experiencing substance use disorder?
    Dr. Gupta. Thank you, Congresswoman, and I really 
appreciate the efforts and the fact that we were able to see 
some offloads. Once again, the interdiction aspect is so 
important.
    Ms. Ms. Wasserman Schultz. Yes. Yes.
    Dr. Gupta. The treatment part is so critical because as we 
try to get people the help, one of the reasons people do not 
get the help is because they don't have the coverage, and the 
very people that we are trying to help often cannot afford to 
see a physician or a provider, and that is tragic, and that is 
unfortunate. So, we know that there is a direct link between 
increasing access to care and getting actually the care, and it 
is critical. That is probably one of the most important pieces 
of the backbone that we are going to need to solve this crisis 
and save the 107,000 lives or perhaps increasing number in the 
future. So, access to care is a critical component, and 
obviously, people who get it are able to then have at least one 
more issue that they don't have to worry about while seeking 
care.
    Ms. Wasserman Schultz. Absolutely, thank you. And I mean, 
we are all painfully aware of how the addiction and overdose 
crisis has impacted our Nation's young people. In fact, the 
final two years of the Trump administration, the overdose 
mortality rate among U.S. adolescents went up 94 percent, and 
this crisis also affects young adults, especially those who may 
struggle to find adequate health insurance. And let me tell 
you, you and I together saw firsthand the efforts that are 
being made with an entire depth full of interdicted drugs in 
South Florida that were brought in, among the largest 
interdictions of drugs in our history that the Coast Guard was 
able to recover, and you and I were there to witness it. So, 
any suggestion that there isn't every effort being made to 
interdict the smuggling of illicit drugs is erroneous.
    So, I want to also just focus on Medicaid expansion and how 
it would help young adults acquire health insurance. How would 
increased access to health insurance lead to access to 
effective treatment and recovery and, thus, improved outcomes 
for young adults and for society generally? I mean, again, we 
have 12 states in the country, mine included, that have not 
expanded Medicaid, and as a result, the rate of drug overdose 
is higher in those states than it is in those states that have 
expanded Medicaid.
    Dr. Gupta. Thank you, Congresswoman. First of all, it is 
important to note that about half of the people with substance 
use disorder have mental health and vice versa. So, this 
overlap in mental health, that also is part of the importance 
of access to care. It is true and tragic that young people are 
perishing at higher rates than ever before, because of the 
overlap of the two. It is also true that majority of people 
that have the 107,000 deaths that happen are between 25 and 54 
years of age. That means that is our working-age population 
across this country, that we are losing 100,000 people at a 
time, every year. So, if you think about it from economics, if 
you think about it common sense, if you think about it from the 
ability to get people, the ability to feel that they get help 
and overlap is critical.
    Ms. Wasserman Schultz. It is basic math. Really, what it 
boils down to is. If you have health insurance, if you can 
afford to pay for your healthcare, you are much more likely to 
be able to get access to that care and prevent either ever 
being addicted to drugs in the first place and be able to 
overcome substance use disorder in the second place. So, I 
appreciate your explanation of how expanding Medicaid is 
absolutely vital in our fight against this terrible crisis.
    The Affordable Care Act provides a powerful tool to fight 
addiction and overdoses, yet Republicans, like Florida Governor 
Ron DeSantis, refused to expand Medicaid to reduce the misery 
and death that this disease brings on. Sadly, because Governor 
DeSantis is immune to facts, science, and even the shame of 
adding to the overwhelming grief that families must endure, 
because of his callous inaction, he is not likely to be moved 
to act. But that doesn't mean we stop calling out his and other 
Republican Governors' cruel indifference and how it compounds 
this crisis and adds to the pain that millions of American 
families will suffer.
    Thank you, Madam Chair. I yield back the balance of my 
time, and, Dr. Gupta, thank you so much for your service.
    Chairwoman Maloney. Thank you. Wasserman yields back.
    Representative Fallon, you are now recognized.
    Mr. Fallon. Thank you, Madam Chair. Dr. Gupta according to 
the DEA, the illegal smuggling of narcotics in our country has 
increased dramatically over the last two years. Do you agree 
with the DEA's assessment that smuggling of cocaine and 
methamphetamine and fentanyl is on the rise?
    Dr. Gupta. Congressman, we are seeing an unprecedented drug 
supply environment that this country has never seen before.
    Mr. Fallon. OK. And I thought it was interesting too, 
Doctor, that the DEA said the only major drug that is actually 
on the decline as far as vis-a-vis illegal smuggling is heroin, 
but it is only because fentanyl has replaced it because it is 
cheaper, it is easier to smuggle, and there is greater profits, 
and it is a lot deadlier. And, Doctor, is it accurate to say 
that fentanyl is, I think it is 50 times more powerful than 
heroin and 100 times more powerful than morphine. Is that 
accurate?
    Dr. Gupta. Congressman, that would be accurate. I just 
wanted to mention one thing----
    Mr. Fallon. Sure.
    Dr. Gupta [continuing]. that we are seeing a transition 
from plant-based organic compound, like heroin, to synthetics, 
and a Pandora's box has been opened with the lab production of 
synthetics like fentanyl.
    Mr. Fallon. OK. And then I think this is important from 
your testimony, one of my colleagues, but the country that the 
lion's share of these drugs are being smuggled from and into 
our country is which country again?
    Dr. Gupta. Obviously where they are being produced is 
Mexico, but obviously it is other nations like China from which 
the resources are coming from.
    Mr. Fallon. Right. So, is it fair to say most of the 
methamphetamine that is smuggled in to the country is produced 
in Mexico, and most of the fentanyl is produced in China. But I 
also heard from some of our DEA agents that fentanyl production 
in Mexico is also on the rise. Is that accurate?
    Dr. Gupta. Congressman, as of today, for North America or 
for United States actually, the precursors are shipped for both 
of these predominantly from China, production for fentanyl and 
meth happens in Mexico, and obviously Americans bear the 
burden.
    Mr. Fallon. Sure, because, you know, you can understand my 
concern. I mean, when you have 107,000 deaths, American deaths 
due to drug overdoses, mostly opioids, and I think you just 
said 80,000 to fentanyl alone. My home state has a 1,254-mile 
border with Mexico, which has been proven time and again to be 
a de facto narco-state. And here we have the worst on record 
for illegal encounters was April with 234,000, but then that 
record was broken in May with a nearly 240,000 illegal border 
crossers. And during the Biden administration, 2.9 million 
illegal border encounters and 700,000 known got-aways, so that 
is at least 3.6 million. And if only one percent of those folks 
that are crossing the border are smuggling narcotics, even 
small amounts, that is 36,000 times. That is remarkable.
    So, here are some stats. The Customs and Border Patrol 
estimate that during the Biden administration, over a million 
pounds of illegal narcotics have been seized along the border, 
and 7,000 pounds of fentanyl, which is enough to kill every 
American multiple times over. So, Secretary Mayorkas last year 
testified in front of the House committee that the border was 
secure, and he then reasonably said there was operational 
control, and I was a little surprised. I think my colleague, 
Representative Biggs, did an outstanding job in his 
questioning. I just want to hear this again. Your testimony is 
as that Director of the National Drug Control Policy for the 
Biden administration, that our border is secure. Is that 
correct, because that is what you said to him.
    Dr. Gupta. Thank you, Congressman. We believe certainly 
that the border is secure with respect to making sure that we 
are seizing both the drugs but also the counternarcotics 
aspect. We are partnering closely with Mexico to ensure that, 
because the problems do not begin or end at the border when 
they are concerned with narcotics and other illegal drugs, we 
want to make sure we are addressing the causes of production, 
the causes of transportation, the routes, as well as shipment 
from China----
    Mr. Fallon. And, Doctor, I apologize. I have to reclaim my 
time only because I have five minutes, but I am just shocked. I 
think that is shockingly inaccurate, and it is just shows just 
gross negligence. I mean, a porous border is a dangerous 
border, and it is an immoral border. And the Mexican drug 
cartels, the fact of the matter is, are controlling our 
Southern border, not our Federal Government. And that is a 
gross dereliction of duty from this administration that is 
putting Americans at risk. And we see that in Texas with the 
political shift. Folks are leaving in droves the Democratic 
Party and coming to the Republican Party because they are sick 
of the chaos, the corruption, the cartels, and the crime.
    Madam Chair, thanks very much. I yield back.
    Chairwoman Maloney. The time has expired. And to followup 
on the discussion we just had, I would like unanimous consent 
to enter into the record President Biden's 2021 Executive Order 
imposing sanctions on transnational cartels and drug 
traffickers. Just this year the administration has extradited 
10 transnational criminals from Mexico to the U.S., including 
several top cartel operatives. The administration has also 
sanctioned another 26 operatives and 10 trafficking 
organizations. So, the truth is the Biden administration has 
been aggressively going after the cartels.
    Now I would like rec to place it in the record.
    Voice. Without objection.
    Chairwoman Maloney. Without objection.
    Chairwoman Maloney. Now, Congressman Ro Khanna, you are now 
recognized.
    Mr. Khanna. Thank you, Madam Chair, and thank you for your 
leadership. It is clear that the Sackler family and Purdue 
Pharma, alongside with other major pharma companies, are 
responsible for massive crimes on the American public and the 
harm that they have caused with the opioid epidemic. We should 
read Beth Macy's work on this. They need to be held 
accountable. They shouldn't be able to hide behind bankruptcy 
court or shield their assets for the crimes they have committed 
on the American public.
    My questioning wants to focus on the current research that 
shows that cannabis can be a key alternative to opioids when it 
comes to relieving pain. Access to cannabis is associated with 
the reduced rates of opioid use and abuse, reduced rates of 
opioid-related hospitalizations, reduced rates of opioid-
related traffic facilities, reduced rates of opioid-related 
drug treatment admissions. One study showed a 64-percent 
reduction in opioid use amongst chronic pain patients who use 
medical marijuana.
    Dr. Gupta, I appreciate your leadership. I imagine you and 
the administration are aware of these studies. Is that true?
    Dr. Gupta. Thank you, Congressman. We are closely 
monitoring these. As someone who has implemented a medical 
cannabis program in the state of West Virginia, I understand 
this work, and we are monitoring those studies as well.
    Mr. Khanna. Thank you, Dr. Gupta. Would you say, based on 
your experience, that it is true that cannabis use is an 
effective alternative for chronic pain patients?
    Dr. Gupta. There is evidence to suggest that in cases of 
certain chronic pain, cannabis can be efficacious.
    Mr. Khanna. Dr. Gupta, when it comes to acute pain, what 
category do opioid prescriptions fall under? Do you know, or I 
can let you know if you don't.
    Dr. Gupta. Most of the opioid prescriptions are Class 2.
    Mr. Khanna. Exactly. Exactly, Schedule II. And yet, 
cannabis is still categorized as Schedule I, as a Schedule I 
drug, which is the most heavily restricted category and which 
prohibits scientists and researchers from conducting rigorous 
large scale-studies on cannabis. Just to be clear, this means 
that cannabis has more restrictive policies then currently 
opioids have, even though opioids have killed tens of thousands 
of Americans. Do you see this, Dr. Gupta, as a contradiction 
that needs to be resolved?
    Dr. Gupta. Thank you, Congressman. Clearly the President 
has been clear about this in regards to the decriminalization, 
but also it is important for us to continue to look at this 
from a research perspective, from a medical use perspective, 
but it is clear the policies that we have had in this country 
with regards to marijuana have not worked, and the President 
has said so.
    Mr. Khanna. I appreciate that, Dr. Gupta, and I admire your 
public service. I know you have to be careful not to get ahead 
of the President, and you are being appropriately diplomatic in 
your responses. But the President has the executive authority 
to direct DEA, HHS, and FDA to consider administratively 
rescheduling marijuana, which would facilitate research, which 
would facilitate patient access. I am for legalizing, at the 
very least decriminalizing, but the President could at least 
make sure that it is rescheduled so it is not more restrictive 
than opioids themselves. Dr. Gupta, you don't have to make 
public comments, but can you assure the committee today that 
privately, at the very least, you will urge the President and 
the administration to follow the best judgment of science here 
and medical research, because that can really help in solving 
this problem.
    Dr. Gupta. Thank you, Congressman. I think it is the 
foundation for so many ways to proceed forward, including our 
current Strategy, is to follow science, follow data, and I can 
commit to you that we are going to continue to do that.
    Mr. Khanna. Thank you, Dr. Gupta. I just would hope you and 
the administration really will consider the rescheduling, and 
to look at what can make a difference in patients' lives, and 
resolve this discrepancy where currently cannabis, which is 
actually more effective and isn't killing thousands of people, 
is more restrictive than the opioids that have done so much 
harm in American life. And I appreciate your public service, I 
appreciate your work, and thank you for appearing before this 
committee.
    Dr. Gupta. Thank you.
    Chairwoman Maloney. Thank you. The gentleman yields back.
    Representative Donalds, you are now called upon. 
Representative Donalds?
    Mr. Donalds. Thank you, Madam Chair. Dr. Gupta, thanks for 
joining us. Quick question, Doctor. You were talking about 
transportation of fentanyl and other opioids, routes, 
manufacturing. You mentioned that there is precursor that comes 
from China. Wouldn't you say that most of the actual pills that 
are pressed with fentanyl are actually manufactured in Mexico?
    Dr. Gupta. Congressman, yes. They are manufactured in 
Mexico after production.
    Mr. Donalds. OK. So, they are manufactured in Mexico, and 
then where do they go from there?
    Dr. Gupta. Congressman, they are often trafficked. We know 
that they end up in the hands of unsuspecting Americans 
oftentimes----
    Mr. Donalds. So, how are they are trafficked into the 
United States, Dr. Gupta?
    Dr. Gupta. Well, we understand that they are trafficked 
across all routes, from land borders, sea border, ports of 
entry, air, as we have been discussing. So, there is all----
    Mr. Donalds. Dr. Gupta, I have a question, side question, 
but it is on the point of trafficking itself. Wouldn't you say 
it would be better for Border Patrol agents to be fully focused 
on the trafficking of narcotics as opposed to processing people 
coming across the border at an illegal point of entry?
    Dr. Gupta. Congressman, I think you are trying to get to 
the point of resources, I guess, and the fact of the matter is 
that we have to be able to do both. But when it comes to 
counternarcotics----
    Mr. Donalds. Dr. Gupta, to your point about resources, 
resources are finite. There are only about so many resources 
you actually have at your disposal. We know that there are only 
about so many men and women of Border Patrol at the disposal of 
the United States. So, would you say it will be more effective 
drug policy to have Border Patrol agents actually monitoring 
drug trafficking than processing people with asylum 
applications who are coming to an illegal point of entry?
    Dr. Gupta. Congressman, what I would say to you is, it is a 
distribution of resources. The President has asked for budget 
to match that, but we must also look at the profits that are 
driving the transnational criminal organization. I say this 
because it is not only drugs. These are poly crime 
organizations that are involved in smuggling people, they are 
smuggling guns, they are smuggling cash.
    Mr. Donalds. Dr. Gupta, I actually completely agree with 
what you just said. They are smuggling people, drugs, cash, and 
weapons. So, if we know these things, as you just alluded, 
isn't it the best policy from the White House, and then 
definitely with respect to your purview in the administration, 
so make sure that border agents are focused on trafficking of 
all of these things as opposed to just processing people just 
on the border, because let me add this point to my question. 
Fine point.
    I have been there four times. I know the President has not 
been, but I have been there four times. When a border agent is 
at the Southern border and a group of people come out of the 
brush crossing our border illegally, the border agent, as 
usually just him by himself or herself, has to stop actually 
patrolling the section they are responsible for, and they have 
to go through the process of doing intake of everybody that 
approached them. I was at a border stop where people came 
across illegally about a week ago in McAllen, Texas. I 
witnessed this firsthand, and that agent is now distracted. 
Now, at that time, when that agent had to deal with people 
coming across the border illegally, on the radio, there were 
runners coming through the McAllen section who did not want to 
give themselves up. And I would assume they were running with 
narcotics, namely fentanyl.
    So, I am going to go back to the original point of 
questioning here. Isn't it better policy in the United States 
for border agents to be focused on trafficking from the drug 
cartels and multinational criminal organizations, as opposed to 
actually going through the process of processing people coming 
into our country at an illegal point of entry?
    Dr. Gupta. Congressman, I hope we can do both, and I hope 
we can do both because what drives----
    Mr. Donalds. Well, hope is not the strategy, Dr. Gupta. 
Hope is not a strategy. Hope is wishful thinking. The reality 
is, as you already dictated, there are finite resources. It is 
only about so many border agents. So, if you have to choose, 
which one do you choose, Dr. Gupta?
    Dr. Gupta. Congressman, if we follow the strategy that is 
laid out, the President's strategy, Drug Control Strategy, I 
think you will find a number of technological aspects for both 
detection and deterrence that allow us to actually save money 
by using technology for that, but we must go after the profits 
of these transnational criminal organizations. They are not----
    Mr. Donalds. I completely agree with you, Dr. Gupta. I am 
going to reclaim my time. We go after their profits. The No. 1 
thing we do is we actually stop processing people at an illegal 
point of entry because then they won't pay the drug cartels. 
Those are profits to traffic them into the United States. The 
drug cartels are using human trafficking into our country as a 
way to actually increase drug trafficking into our country, 
which is a direct thing that goes with the amount of fentanyl 
deaths in the United States.
    Thank you, Madam Chair, for the indulgence. I yield back 
the rest of my time.
    Chairwoman Maloney. The gentleman's time has expired. OK.
    Representative DeSaulnier, you are now recognized.
    Mr. DeSaulnier. Thank you, Madam Chair. Thank you, Doctor, 
for being here. Thank you for your lifetime work in this field.
    I want to talk to you a little bit about and very much 
appreciate the evidence-based approach. We have had success in 
a bipartisan way on criminal justice reform. We have had people 
like the Heritage folks agree that evidence-based research 
policies can work and they are effective, and they clearly work 
when it comes to substance abuse. Only 30 million Americans, 
who have substance abuse problems, almost 70 percent of them 
say they are either in recovery or have recovered. For those of 
us who are familiar with recovery, there is certainly an 
argument to be made you are always in recovery once you have 
become addicted.
    One of my frustrations, Doctor, is, and I am sure it is 
yours as well, the scale of this country, your institution. I 
was at an event this Sunday for a sober living nonprofit that I 
have been involved with since I was in local government 30 
years, myself and the presiding judge of our drug court, who is 
a Republican nominee. And we were talking about, ironically, 
the last comments about hope and the hope of having programs 
like that at a community level where users and families, users 
of services, addicted people, can see them work because of the 
evidence-based research.
    So, the frustration is getting the Federal Government to be 
in the role of, from my perspective, identifying those programs 
that work and then incentivizing investments in that programs, 
in those programs at a community level. Could you speak to 
that, both your frustrations and the successes? I look at 
places like Johns Hopkins and UCSF here where I live, where the 
exponential research and understanding of addiction and 
neuroscience is so wonderful, but then deploying that to the 
communities that need it are so frustrating.
    Dr. Gupta. Thank you, Congressman. I think it is an 
important piece to understand at least two-thirds of people 
that are incarcerated have a diagnosis of substance use 
disorder or addiction. Therefore, it is important, first of 
all, to think about all the programs that could do a pre-arrest 
diversion, like deflection programs. We have just put out a 
state model law that put public safety and public health 
communities to work together, to get people the help they need 
in lieu of arrest and incarceration. It says money is common 
sense. Second, drug courts. I want to make sure that before 
either pre-trial diversion, drug courts, and other aspects like 
that, we have robust training. The Strategy calls for ensuring 
that people have the opportunity for non-violent crimes to 
have, to move on, to make sure that happens.
    Treatment for people incarcerated is critical, and we are 
doing that because people become more productive. The death 
rates declined significantly at the scene in states like Rhode 
Island when we can treat people, and recidivism in all quarters 
costs go down as well. And then, reentry. It is important to 
make sure that when people are ready to reenter society, we get 
them the tools that need to be successful, and that is where 
treatment continuing and community connection become important. 
And then recovery support services. Understanding the recovery 
is not about a treatment only, but it is about all the support 
that individual needs with their health, with their home, with 
their community, and with their purpose in life to make sure 
that they have all of those surrounding services and supports 
to make them successful across the lifetime.
    Mr. DeSaulnier. A followup on that. Having had multiple 
discussions with Secretary Walsh, and a member of the Education 
and Labor Committee, and chair of that committee's Health, 
Employment, Labor, and Pension Subcommittee, and with Xavier 
Becerra, a good friend, how do we coordinate those services? So 
again, at the community level, years ago I had a conversation 
when I was in the legislature, and we were dealing with both 
criminal justice reform that has been successful here in 
California and the ACA. I had the warden of San Quentin tell 
me, why are you surprised that we release people from here back 
into your district in Richmond, California or Oakland, and they 
are back here within a month when we only give them $200 and 
say ``good luck.'' So, how are we coordinating those services 
at the Federal level and at the state level?
    Dr. Gupta. At a Federal level, Congressman, it is important 
for us to be working together. That is where ONDC comes in with 
the Strategy because it allows us to work with Health and Human 
Services, with Labor, with HRSA, with making sure that we have 
both recovery-ready work force as well, but also recovery-ready 
employers and employment places that allow that to happen. So, 
it is a matter of coordination, and that is exactly what we are 
doing by bringing all the 18 drugs controlled by the Agency 
together and work on it collectively.
    The state level, I am proud when I talk to leaders, like 
Governor Sununu in New Hampshire, who is actually leading 
recovery-ready work force, recovery-ready workplaces. I visited 
him, and I was happy to see how far we are moving when we 
decided that this is the right thing to do because it makes 
sense. And there are Governors across the country that are 
actually moving to understand it is effective. There are 23 
million Americans that the President called out in the State of 
Union speech that are on path to recovery. We need to support 
them and do everything we can to provide them the resources.
    Mr. DeSaulnier. Thank you, Doctor. Public health is public 
safety, right? I yield back.
    Dr. Gupta. Yes, sir. Thank you.
    Chairwoman Maloney. Representative Comer, you are now 
recognized.
    Mr. Comer. Thank you, Madam Chair. Dr. Gupta, is fentanyl 
the deadliest drug currently coming across the border?
    Dr. Gupta. Congressman, there are some others, but 
predominantly it is.
    Mr. Comer. And is fentanyl being manufactured in 
clandestine labs on the Mexican side of the border?
    Dr. Gupta. Yes, Congressman.
    Mr. Comer. And when they are manufacturing these synthetic 
opioids, where are they obtaining the precursor chemicals from?
    Dr. Gupta. Mostly from China, Congressman.
    Mr. Comer. What is this administration doing to hold China 
accountable for helping the cartels create and distribute 
fentanyl?
    Dr. Gupta. Congressman, I agree with the words of Secretary 
Blinken, who spoke recently about China policy, which is that 
we have to work with the PRC to make sure that the criminal 
elements within the PRC are held to account. And if China is to 
be the global leader and demonstrate the leadership, that it 
must actually be held accountable.
    So, one of the things we are doing is I am working very 
closely with our Ambassador, Nick Burns, in Beijing to see how 
we work together. We have very specific asks of the People's 
Republic of China, and we have provided them the asks, both in 
meetings as well as in writing. Those asks are that we want you 
to make sure that there is labeling and you are following the 
uniform international shipping standards. We want you to make 
sure your companies know the customer, KYC, Know Your Customer 
protocols all the way to the end user, and making sure that 
some of these dual-use chemicals, we are keeping a track and 
working mutually to do that. Now that spoken----
    Mr. Comer. Let me reclaim my time there. You know, we 
obviously don't feel that that is a firm stance with China. We 
all know from history, China is not the most truthful country 
we deal with. They steal our patent. They steal our 
intellectual property. They are contributing to the fentanyl 
crisis we have here in America. Now back to the Mexican drug 
cartels, they smuggle both people and drugs in their 
operations, correct?
    Dr. Gupta. Correct.
    Mr. Comer. Are the cartels using their human smuggling 
operations to facilitate their drug smuggling operations?
    Dr. Gupta. Congressman, we believe sometimes they are and 
sometimes they are not, so it depends. There are reasons for 
both.
    Mr. Comer. Well, I can tell you, and the reason you have 
had so many questions is the Republicans on the Oversight 
Committee, we have been to the border numerous times, and the 
drug cartel tell us that, in fact, that drug cartels use human 
smugglers to get their fentanyl across the border. So my 
question, sir, is why was the Southern border only mentioned 
twice in the National Drug Control Strategy for 2022?
    Dr. Gupta. Congressman, I might point to you that part of 
the responsibility ONDC is to provide border strategy. So, 
there is an entire accompanying document that focuses just on 
the border strategy: the Southwest border, the Caribbean 
border, and the Northern border. So, there is an entire 
complement that has the border strategies, the full written 
complement.
    Mr. Comer. Dr. Gupta, you know, you have been asked this 
question by many Republicans on the committee, and I am going 
to give you one last opportunity to answer the question since I 
am the last question, and I want to remind you that you are 
under oath. But do you believe the Biden administration is 
doing everything it can to control the illicit flow of fentanyl 
across the Southern border?
    Dr. Gupta. Congressman, I believe we can do more, and I 
think we need to do more. And I believe part of that requires 
making sure that we are holding Mexico and Mexican Government 
accountable with the same level of energy and enthusiasm that 
we are working on South Dong, gun trafficking, as well as cash 
trafficking. We want them to act accordingly and as robust as 
we are because we put a lot of resources into Mexico. We could 
do more in terms of President's budget and making sure it kind 
of helps us with making sure that folks have the technology, 
the resources, as well as infrastructure. We think we can do 
more to stop the shipment of precursors from China and make 
sure the next country in the line does not substitute for that.
    Mr. Comer. And I will close with this. My time is about up. 
You know, there aren't many areas right now, unfortunately, 
where there is bipartisan agreement in Congress. There is one 
agreement that the fentanyl is coming across the Southern 
border, and this administration needs to do more. When you ask 
for more funding and when we talk to the Border Patrol, they 
say that this administration continues to do things to tie 
their hands, like the recent announcement to suspend Title 42, 
that is only making the illegal border crossings significantly 
increase. When the border crossing increases, there is more 
drugs at----
    Chairwoman Maloney. The gentleman's time has expired.
    Mr. Comer. Now this administration is going to have to get 
serious. Madam Chair, I will wrap it up here. You can't have a 
committee hearing on the National Drug Control Strategy and the 
Federal response without addressing the crisis at the Southern 
border, and that is what we have is a crisis. And this 
administration's response is substandard and certainly making a 
bad situation worse. I yield back.
    Chairwoman Maloney. The gentleman yields back.
    Representative Tlaib, you are now recognized.
    Ms. Tlaib. Thank you so much, Chairwoman, and thank you Dr. 
Gupta for being with us today. You know, I know addiction is a 
critical issue. You know, even as my colleagues focus so much 
on some of the border and immigration policies, I know within 
our own country, we just have not done enough to push back in 
understanding or push back on this rhetoric that we don't have 
a substance abuse issue and problem in our country, especially 
with even some, you know, legal pharmaceutical companies 
pushing, you know, contributing to the opioid crisis right here 
at home. And many of my colleagues continue to actually benefit 
through political contributions from some of the same folks 
that continue to push those drugs onto our families.
    You know, one of the things I want to talk about is that, 
you know, expanding access to an opioid overdose reversal 
medication as you know, the current Narcan, would help achieve 
so much in saving tens and thousands of lives, as you know, 
Doctor. And we have seen in places like Massachusetts and 
where, you know, Narcan distribution program reduce opioid 
overdoses and deaths by an estimated 11 percent without 
increasing opioid use.
    And if I may, Chairwoman, I would like to submit for the 
record a study to show some of the impact of that program, that 
distribution program.
    Chairwoman Maloney. Without objection.
    Ms. Tlaib. Thank you. To maximize the lifesaving potential 
of these treatments, it is imperative, as you know, Doctor, 
that the overdose reversal medication are affordable and easily 
accessible in every city and town across the United States.
    Doctor, how does the current administration's National Drug 
Control Strategy increase access to Narcan so it can be readily 
available for people who need it the most, including those 
historically neglected communities like mine? I mean, you 
should know this, you know, seeing some of the information 
coming out, I think, with the past decade, over 2,000 of my 
fellow Detroiters lost their lives. Many corporate funding 
pushed, you know, addiction on them. Of them, 364 overdose 
deaths in 2019, 86 percent of those deaths were involved 
opioid. And so what can you tell me that you all are doing to 
increase the access?
    Dr. Gupta. Thank you, Congresswoman. Naloxone or Narcan, 
this is about making sure it is affordable and it is 
accessible. And one of the things we are doing is making sure 
that states have a set-aside amounts to be able to both acquire 
as well as have a distribution plan to especially the most 
vulnerable communities within the states to be able to 
distribute. It does no good sitting on the shelf because it 
expires. It is not saving lives. But we are very intentional 
about making sure that we are removing the affordability aspect 
of a naloxone and we are providing naloxone in the hands of 
people who need it because we know that if we do not, we are on 
track to have 163,000 deaths a year by 2025. But if we do what 
the Strategy calls for, we can reduce that number literally by 
half to 81,000.
    And if you accumulate over the next three years, we are 
talking about hundreds and thousands of American lives that can 
be saved, and naloxone is lifesaving. For every dollar, there 
is a $2,760 return investment. It is the biggest bang for the 
buck in terms of saving lives, and it is a critical aspect of 
the Strategy. So, we are moving forward to make sure that we 
are working closely with HHS, with our other Federal agencies 
and state partners, as well as local partners.
    Ms. Tlaib. Well, thank you so much. One of the things as a 
parent I want to talk about is, how do we have it accessible in 
some of our high school and some universities and campuses, 
because, you know, I have been hearing obviously an increase in 
addiction played among our, you know, college age, I would say, 
and youth. And so anything that we are doing in that regard?
    Dr. Gupta. Thank you, Congresswoman. It breaks my heart 
every time we see children especially die, unknowingly, 
unsuspectingly, because of the abuse, a counterfeit pill. It is 
important while we work on the supply side, we also make sure 
that kids are aware. This is no different than learning CPR, 
than having AED device in the wall. So, it is going to be very 
important for us to make sure we are removing the stigma out of 
this and getting people to understand this is about saving a 
life, not making judgments, because we believe every life is 
precious and it is worth saving.
    Ms. Tlaib. Absolutely. And you know, again, as I look at 
our country, if it is not this crisis of addiction, there are 
others in the future, so we really have to try to work on this 
holistically as well. So, thank you all so much, and I yield, 
Madam Chair.
    Chairwoman Maloney. Thank you. Before we close, I want to 
offer the ranking member an opportunity to offer any closing 
remarks he may have. Ranking Member Comer, you are now 
recognized.
    Mr. Comer. Thank you, Madam Chair, and, again, Dr. Gupta, 
thank you so much for coming before this committee. We 
appreciate your willingness to give us an update of what this 
administration is focused on with respect to drug control. But 
I think you heard loud and clear that Republicans are concerned 
with the lack of border security along the Southern border, and 
we get this from many conversations with Border Patrol and with 
local law enforcement. Even in Kentucky, in rural Kentucky, my 
drug task force agents tell me that all the fentanyl and all of 
the crystal meth, which are the two main drugs of choice right 
now on the street in rural Kentucky, in rural America, for that 
matter, are coming across the Southern border.
    So, I don't think it makes a lot of sense for this 
administration to say they are focused on drug control when we 
have a border that is wide open. And this administration 
continues to do things to tie the hands of our border agents by 
announcing that they are going to do things like suspend Title 
42. We need to get serious about the border, and we need to 
hold Mexico and China accountable for the drugs that they are 
working together to manufacture in Mexico with inputs from 
China that they are sending across the border. And I think that 
we can do that, but this administration is going to have to 
take this seriously and greatly reverse course with respect to 
border security on the Southern border.
    With that, Madam Chair, I yield back, and thank you again 
for holding this hearing.
    Chairwoman Maloney. Thank you for participating, and I 
thank our panelists and all of my colleagues for participating. 
And before I get to my closing statement, it is clear we need a 
comprehensive approach to this crisis.
    I would like to enter into the record a Customs and Border 
Protection Study showing that as of 2019, 90 percent of heroin 
and 80 percent of the fentanyl coming into the country, a lot 
arrived at a legal border crossing point, and Trump's border 
wall would not have stopped any of these opioids. And diverting 
resources away from proven interdiction efforts to build a wall 
would be poor use of taxpayers money.
    So, I ask unanimous consent to put this U.S. Customs and 
Border Protection Report into the record.
    Without objection.
    Chairwoman Maloney. The opioid epidemic has been ravaging 
this country for years, and it has affected all of our 
communities in red states and blue states. Often, it can feel 
hopeless. But as we heard from Director Gupta, the Biden-Harris 
Administration is committed to combating the opioid crisis that 
has already made meaningful progress, and it has a clear 
strategy to stop fentanyl from devastating our communities and 
families. This clear plan is what gives me hope.
    I am grateful because the administration has adopted a 
public health and harm reduction approach that will help ensure 
people with addiction receive lifesaving treatment regardless 
of who they are and where they live. That includes the 
director's announcement today that he supports extending the 
use of telehealth services to provide medication for opioid use 
disorder. The administration has also laid out a plan to build 
on the success of seizing illicit drugs at our Southern border 
by encouraging Federal, state, and local law enforcement 
agencies to work together and by investing in the right 
technology to keep our Southern borders secure.
    Today's hearing makes clear that we cannot reduce the 
prevalence of drugs in our communities through interdiction and 
law enforcement alone, nor is it possible through public health 
measures alone. Instead, we need to address both supply and 
demand that requires a whole-of-government approach with public 
health and law enforcement agencies working together to get the 
job done. Every life lost to an overdose is a tragedy. The 2022 
National Drug Control Strategy provides the roadmap to prevent 
these tragedies and to finally address this crisis.
    Now, Democrats and Republicans must work together through 
legislation and appropriations to make this plan a reality. We 
should start by passing my CARE Act, which would further expand 
access to key resources like treatment, overdose reversal 
medications, and fentanyl test strips by providing the 
comprehensive sustained funding needed to finally overcome 
overdose crisis.
    So, with that, and in closing, I want to thank all of our 
panelists for their remarks, and I want to commend my 
colleagues for participating in this event.
    With that without objection, all members have five 
legislative days within which to submit extraneous materials 
and to submit additional written questions for the witnesses to 
the chair, which will be forwarded to the witnesses for a 
response. I ask our witness to please respond as promptly as 
you possibly can.
    Chairwoman Maloney. And with that, this hearing is 
adjourned.
    [Whereupon, at 3:37 p.m., the committee was adjourned.]