[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
COMBATING EXISTING AND EMERGING
ILLICIT DRUG THREATS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
FEBRUARY 6, 2025
__________
Serial No. 119-4
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Published for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
59-561 PDF WASHINGTON : 2025
-----------------------------------------------------------------------------------
COMMITTEE ON ENERGY AND COMMERCE
BRETT GUTHRIE, Kentucky
Chairman
ROBERT E. LATTA, Ohio FRANK PALLONE, Jr., New Jersey
H. MORGAN GRIFFITH, Virginia Ranking Member
GUS M. BILIRAKIS, Florida DIANA DeGETTE, Colorado
RICHARD HUDSON, North Carolina JAN SCHAKOWSKY, Illinois
EARL L. ``BUDDY'' CARTER, Georgia DORIS O. MATSUI, California
GARY J. PALMER, Alabama KATHY CASTOR, Florida
NEAL P. DUNN, Florida PAUL TONKO, New York
DAN CRENSHAW, Texas YVETTE D. CLARKE, New York
JOHN JOYCE, Pennsylvania, Vice RAUL RUIZ, California
Chairman SCOTT H. PETERS, California
RANDY K. WEBER, Sr., Texas DEBBIE DINGELL, Michigan
RICK W. ALLEN, Georgia MARC A. VEASEY, Texas
TROY BALDERSON, Ohio ROBIN L. KELLY, Illinois
RUSS FULCHER, Idaho NANETTE DIAZ BARRAGAN, California
AUGUST PFLUGER, Texas DARREN SOTO, Florida
DIANA HARSHBARGER, Tennessee KIM SCHRIER, Washington
MARIANNETTE MILLER-MEEKS, Iowa LORI TRAHAN, Massachusetts
KAT CAMMACK, Florida LIZZIE FLETCHER, Texas
JAY OBERNOLTE, California ALEXANDRIA OCASIO-CORTEZ, New York
JOHN JAMES, Michigan JAKE AUCHINCLOSS, Massachusetts
CLIFF BENTZ, Oregon TROY A. CARTER, Louisiana
ERIN HOUCHIN, Indiana ROBERT MENENDEZ, New Jersey
RUSSELL FRY, South Carolina KEVIN MULLIN, California
LAUREL M. LEE, Florida GREG LANDSMAN, Ohio
NICHOLAS A. LANGWORTHY, New York JENNIFER L. McCLELLAN, Virginia
THOMAS H. KEAN, Jr., New Jersey
MICHAEL A. RULLI, Ohio
GABE EVANS, Colorado
CRAIG A. GOLDMAN, Texas
JULIE FEDORCHAK, North Dakota
------
Professional Staff
MEGAN JACKSON, Staff Director
SOPHIE KHANAHMADI, Deputy Staff Director
TIFFANY GUARASCIO, Minority Staff Director
Subcommittee on Health
EARL L. ``BUDDY'' CARTER, Georgia
Chairman
NEAL P. DUNN, Florida, Vice DIANA DeGETTE, Colorado
Chairman Ranking Member
H. MORGAN GRIFFITH, Virginia RAUL RUIZ, California
GUS M. BILIRAKIS, Florida DEBBIE DINGELL, Michigan
DAN CRENSHAW, Texas ROBIN L. KELLY, Illinois
JOHN JOYCE, Pennsylvania NANETTE DIAZ BARRAGAN, California
TROY BALDERSON, Ohio KIM SCHRIER, Washington
DIANA HARSHBARGER, Tennessee LORI TRAHAN, Massachusetts
MARIANNETTE MILLER-MEEKS, Iowa MARC A. VEASEY, Texas
KAT CAMMACK, Florida LIZZIE FLETCHER, Texas
JAY OBERNOLTE, California ALEXANDRIA OCASIO-CORTEZ, New York
JOHN JAMES, Michigan JAKE AUCHINCLOSS, Massachusetts
CLIFF BENTZ, Oregon TROY A. CARTER, Louisiana
ERIN HOUCHIN, Indiana GREG LANDSMAN, Ohio
NICHOLAS A. LANGWORTHY, New York FRANK PALLONE, Jr., New Jersey (ex
THOMAS H. KEAN, Jr., New Jersey officio)
MICHAEL A. RULLI, Ohio
BRETT GUTHRIE, Kentucky (ex
officio)
C O N T E N T S
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Page
Hon. Earl L. ``Buddy'' Carter, a Representative in Congress from
the State of Georgia, opening statement........................ 1
Prepared statement........................................... 3
Hon. Diana DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 6
Prepared statement........................................... 9
Hon. Brett Guthrie, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 12
Prepared statement........................................... 14
Hon. Lori Trahan, a Representative in Congress from the
Commonwealth of Massachusetts, opening statement............... 17
Prepared statement........................................... 19
Witnesses
Raymond Cullen, Family Advocate.................................. 22
Prepared statement........................................... 25
Sheriff Michael Bouchard, Vice President, Government Affairs,
Major County Sheriffs of America............................... 30
Prepared statement........................................... 32
Answers to submitted questions............................... 231
Timothy W. Westlake, M.D., Emergency Physician, Oconomowoc
Memorial Hospital, ProHealth Care Medical System............... 43
Prepared statement........................................... 45
Regina M. LaBelle, Professor of Addiction Policy, Georgetown
University Graduate School of Arts and Sciences................ 58
Prepared statement........................................... 60
Answers to submitted questions............................... 233
Deepa Camenga, M.D., Chair, Committee on Substance Use and
Prevention, American Academy of Pediatrics..................... 65
Prepared statement........................................... 67
Answers to submitted questions............................... 236
Submitted Material
Inclusion of the following was approved by unanimous consent.
List of documents submitted for the record....................... 144
Letter of January 29, 2025, from William J. Johnson, Executive
Director, National Association of Police Organizations, to
Senator Bill Cassidy and Mr. Griffith.......................... 145
Letter of January 31, 2025, from Association of State Criminal
Investigative Agencies, et al., to House Speaker J. Michael
Johnson and Mr. Griffith....................................... 146
Letter of February 5, 2025, from American Academy of Pain
Medicine, et al., to Mr. Carter of Georgia and Ms. DeGette..... 148
Article of February 3, 2025, ``B.C. organized crime expanding
export of fentanyl and other drugs,'' by Kim Bolan, Vancouver
Sun............................................................ 151
Letter of February 6, 2025, from Tom Kraus, Vice President,
Government Relations, American Society of Health-System
Pharmacists, to Mr. Guthrie, et al............................. 153
Letter of February 6, 2025, from Sandra Faeh, President, American
Veterinary Medical Association, to Mr. Guthrie and Mr. Pallone. 160
Article of February 5, 2025, ``DOGE Aides Search Medicare Agency
Payment Systems for Fraud,'' by Anna Wilde Mathews and Liz
Essley Whyte, Wall Street Journal.............................. 162
Article of February 3, 2025, ``Elon Musk's Blitz Shakes U.S.
Government as He Sweeps Through Agencies,'' by Jonathan Swan,
et al., The New York Times..................................... 165
Letter of February 6, 2025, from Susan Ousterman to Mr. Guthrie
and Mr. Pallone................................................ 184
Letter of February 3, 2025, from Brian Hurley, President,
American Society of Addiction Medicine, to Hon. Chuck Grassley,
et al.......................................................... 187
Letter of February 3, 2025, from ACLU of Nevada, et al., to
Senate Majority Leader John Thune, et al....................... 193
Letter of February 4, 2025, from Jesselyn McCurdy, Executive Vice
President of Government Affairs, The Leadership Conference on
Civil and Human Rights, to House Speaker Mike Johnson and House
Minority Leader Hakeem Jeffries................................ 201
Article of December 9, 2023, ``How a factory city in Wisconsin
fed military-grade weapons to a Mexican cartel,'' by Sarah
Kinosian, Reuters.............................................. 204
Article of April 16, 2024, ``How the United States Arms the
Mexican Cartels,'' Rolling Stone, book excerpt by Ieva
Jusionyte...................................................... 217
Memorandum of January 21, 2025, ``Interim Policy Changes
Regarding Charging, Sentencing, And Immigration Enforcement,''
Acting Deputy Attorney General, Department of Justice.......... 225
Report, ``PART VII: Firearm Commerce, Crime Guns, and the
Southwest Border,'' National Firearms Commerce and Trafficking
Assessment (NFCTA): Protecting America from Trafficked
Firearms, Volume Four, Bureau of Alcohol, Tobacco, Firearms and
Explosives \1\
Article of February 4, 2025, ``Virginia community health centers
close over federal funding access,'' by Adrienne Hoar McGibbon,
VPM News....................................................... 228
----------
\1\ The report has been retained in committee files and is included in
the Documents for the Record at https://docs.house.gov/meetings/IF/
IF14/20250206/117857/HHRG-119-IF14-20250206-SD003-U1.pdf.
COMBATING EXISTING AND EMERGING ILLICIT DRUG THREATS
----------
THURSDAY; February 6, 2025
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:00 a.m., in
the John D. Dingell Room 2123, Rayburn House Office Building,
Hon. Earl L. ``Buddy'' Carter (chairman of the subcommittee)
presiding.
Members present: Representatives Carter of Georgia, Dunn,
Griffith, Bilirakis, Crenshaw, Joyce, Balderson, Harshbarger,
Miller-Meeks, Cammack, Obernolte, James, Bentz, Langworthy,
Kean, Rulli, Guthrie (ex officio), DeGette (subcommittee
ranking member), Ruiz, Dingell, Kelly, Barragan, Schrier,
Trahan, Veasey, Fletcher, Ocasio-Cortez, Auchincloss, Carter of
Louisiana, and Landsman.
Also present: Representatives Latta, Tonko, and McClellan
Staff present: Ansley Boylan, Director of Operations;
Jessica Donlon, General Counsel; Kristin Fritsch, Professional
Staff Member, Health; Sydney Greene, Director, Finance and
Logistics; Jay Gulshen, Chief Counsel, Health; Calvin Huggins,
Staff Assistant; Megan Jackson, Staff Director; Sophie
Khanahmadi, Deputy Staff Director; Chris Krepich, Senior
Communication Advisor; Brayden Lacefield, Special Assistant;
Joel Miller, Chief Counsel; Emily Hale, Staff Assistant;
Jackson Rudden, Staff Assistant; Chris Sarley, Member Services/
Stakeholder Director; Emma Schultheis, Clerk, Health; Kaley
Stidham, Press Assistant; Lydia Abma, Minority Policy Analyst;
Sam Avila, Minority Health Fellow; Shana Beavin, Minority
Professional Staff Member; Rasheedah Blackwood, Minority
Intern; Keegan Cardman, Minority Staff Assistant; Waverly
Gordon, Minority Deputy Staff Director and General Counsel;
Tiffany Guarascio, Minority Staff Director; Una Lee, Minority
Chief Counsel, Health; and Hannah Treger, Minority Intern.
Mr. Carter of Georgia. The subcommittee will come to order.
The Chair recognizes himself for 5 minutes for an opening
statement.
OPENING STATEMENT OF HON. EARL L. ``BUDDY'' CARTER, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA
Ladies and gentlemen, thank you for being here today as we
gavel in the first Energy and Commerce Subcommittee on Health
hearing.
American families across the country continue to suffer
from the failures of the Biden-Harris administration's
disastrous 4 years and its inability to address one of the
greatest public health threats of our lifetimes: the illicit
drugs pouring over our borders. Under the previous
administration, the United States experienced a historic rise
of drug overdoses and poisonings driven by an increased supply
of synthetic opioids such as illicit fentanyl and its analogs.
Last fiscal year, Customs and Border Protection confiscated
over 21,000 pounds of fentanyl at our borders. That is enough
fentanyl to kill every American several times over, and that is
just the drugs we know about.
Under the Biden-Harris administration we saw rates of
overdose and poisoning deaths skyrocket, peaking at nearly
108,000 in 2023, driven by the surge of fentanyl coming across
our borders. Illicit fentanyl overdoses are now the number 1
cause of death among adults 18 to 45. Each year, more Americans
are dying from illicit fentanyl than the number of Americans'
lives lost during the Vietnam War.
However, I believe we have a great opportunity to make
significant and sustainable progress in combating this crisis.
To do so we must continue to expand availability of overdose-
reversible treatments like naloxone, removing the stigma
associated with curing it and making it as common as a fire
extinguisher. Every school in America should have access to
naloxone.
We must secure our borders to stop the scourge of illegal
drugs, especially poisons like illicit fentanyl. President
Trump has already made progress to address the fentanyl crisis
by forcing Mexico and Canada to come to the negotiating table.
With President Trump's leadership, we must continue to crack
down on China, Mexico, and anyone who smuggles fentanyl and
other synthetic drugs across our borders with the sole
intention of preying on Americans.
Additionally, this committee is already taking action to
help keep illicit fentanyl out of our communities and save
lives. Later today, the House will vote on a bill developed by
this committee, the Halt All Legal Trafficking of Fentanyl Act,
which will take the critical step of permanently scheduling all
fentanyl-related substances as schedule I drugs under the
Controlled Substances Act.
These tools and solutions address today's problem, but like
the evolution of the opioid crisis from the overprescribing of
OxyContin to today's scourge of synthetic opioids like
fentanyl, we must prepare for what is next.
In this hearing we will hear from our witnesses not just on
the illicit drugs threatening our communities today but
potential new threats that if left unaddressed will be driving
this crisis tomorrow. I look forward to that testimony and
working alongside my colleagues on addressing these issues.
[The prepared statement of Mr. Carter of Georgia follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Carter of Georgia. At this time I would like to yield 1
minute to the gentleman from Pennsylvania, Dr. Joyce, for a
statement.
Mr. Joyce. Thank you, Chairman Carter, and thank you for
holding this important hearing.
I want to take this opportunity to introduce Mr. Ray
Cullen, who is here with his wife, Deb. They come from
Pennsylvania's 13th Congressional District, and they tragically
lost their son to fentanyl poisoning. Zach was out with
friends, and they were sold drugs laced with fentanyl. And on
that tragic night, Zach stopped breathing.
The compelling story that they brought to me and have
continued to advocate specifically for this HALT Fentanyl piece
of legislation is not only important to them individually, them
as a family, but is important to all of America. And I am proud
that both Ray and Deb Cullen have brought this story to the
halls of Congress to be able to share it with us today.
Thank you, Mr. Chairman. And I yield back.
Mr. Carter of Georgia. Thank you, Dr. Joyce.
I would now like to yield 1 minute to the gentleman from
Michigan, Representative James, for his statement.
Mr. James. Thank you, Mr. Chairman.
Today I have the distinct honor and privilege of
introducing a friend, outstanding servant in southeast
Michigan, law enforcement hero, Pam's husband, and brother
Rice, class of 1999 commencement speaker, Sheriff Mike
Bouchard.
I am so proud that he is from my district. And as our
Nation is facing an all-out assault on cartels and adversaries
like CCP, the illicit drug epidemic is devastating our families
and communities, and Sheriff Mike Bouchard and his team on the
front lines. He knows firsthand what is going on in our
communities, and he has been successful leading southeast
Michigan. In May 2024, 500 grams of cocaine, 50 grams of
fentanyl and OxyContin were seized. April 2024, $20,000 in
cocaine, fentanyl, and other drugs confiscated. March 2023,
41.5 kilos of fentanyl, enough to kill all 10.3 million
Michiganders, were confiscated because of the leadership of
Sheriff Mike Bouchard and his phenomenal team.
I am grateful to him for his leadership. I am grateful for
his friendship, and I am excited to hear about his leadership
and lessons learned today.
Mr. Chairman, with that, I yield.
Mr. Carter of Georgia. Thank you, Representative James.
The Chair now recognizes the gentlelady from Colorado,
Representative DeGette, for 5 minutes for an opening statement.
OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Ms. DeGette. Thank you so much, Mr. Chairman. I am very
happy to be the ranking member on this committee, and I am
looking forward to working with you and all of our colleagues
on both sides of the aisle to advance strong bipartisan
solutions to the issues we face. And I, of course, join you in
saying we need to be safe from dangerous drugs like fentanyl.
I do, regrettably, have to correct the record already, even
though it is just my first opening statement.
Under the Biden administration, the Biden administration
was also working hard to curb fentanyl, and that is why last
year, the deaths from fentanyl were below 90,000, which was a
decrease from 128,000 just the year before. So I hope we can
continue this, but I think demagoguing on the Biden
administration's success and saying that deaths were higher is
inaccurate.
Something else I want to talk about is the developments
that we have seen in the last couple of weeks under the new
Trump administration. Donald Trump kicked off his term with
actions that led to a daylong freeze of Medicaid funds for
every one of our States. Last Monday, Denver Health, which is
our safety net hospital that serves a regional area in the
Rocky Mountains, called saying all of their Medicaid funds had
been frozen and they couldn't provide medical services to
thousands of people.
Now, in response to Donald Trump's Executive orders then,
CDC removed from its website the guidance that doctors rely on
to treat patients every day and data researchers use to improve
public health.
I got a call from my daughter. Some of you guys know my
daughter, Raphaela. She is an internal medicine doctor at UCSF
in San Francisco. She told me that they couldn't get the CDC
guidance on birth control or on vaccines, and as of 2 days ago
they still couldn't get the guidance on birth control. And, of
course, there is no available guidance for healthcare for LGBTQ
individuals anywhere.
Also, NIH grantmaking for critical biomedical research is
at a dead stop with no end in sight. I got calls from some
researchers at Anschutz Medical Center, which does important,
lifesaving research, and they were unable to access their grant
dollars for some time last week. And now a 23-year-old SpaceX
intern has been given access to systems containing sensitive
information about Medicare and Medicaid.
So Mr. Chairman, I was just saying to you my constituents
are terrified about what Elon Musk and his lawless DOGE are
going to do with that access. I had over 500 phone calls in my
office in the last 2 days, many of the individuals who were
sobbing. So as Donald Trump ground NIH to a halt and disrupted
funding for safety-net healthcare, where is the outrage there
on the other side? I have only heard Democrats speaking up. Are
all of you afraid of Donald Trump? Do you agree with this
lawless assault on science?
The Constitution obliges the President to faithfully
execute the laws that Congress creates, and Article I of the
Constitution gives Congress that authority. So why aren't we
exerting it? The Founders envisioned the checks and balances in
our Constitution as necessary to curb abuses in the Government.
Quote, ``Ambition must be made to counteract ambition.'' That
is from James Madison. And the Government must be obliged to
control itself. We need to assert Congress' authority. It is
shameful that Republicans have sat by while Congress, the first
branch of government and the voice of the people, has been
silenced in this diminished state and allowed the executive
branch and somebody who is not even elected or appointed to
office to ignore the law.
So let me assure you, our constituents are watching what is
happening. They are not happy. In the midst of this
lawlessness, this dangerous agenda to take healthcare away from
hardworking Americans is not going to go. We are going to fight
with every fiber of our being to make sure that that happens.
So that is pretty much how I am feeling this morning. And I
am going to tell you, if you try to cut $2 trillion to Medicaid
in order to pay for tax cuts for the wealthiest in this
country, this is not going to fly. We need to have quality
healthcare for every American. We need to have biomedical
research that will find cures for the diseases that we all care
about, and we need to continue to have adequate and full
information so that everybody can get the quality healthcare
that they need.
So I guess I look forward to working with you. It is going
to be a long 2 years. I yield back.
[The prepared statement of Ms. DeGette follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Carter of Georgia. And with that, the lady yields back.
I now recognize the chairman of the full committee,
Chairman Guthrie, for 5 minutes for an opening statement.
OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF KENTUCKY
Mr. Guthrie. Thank you, Chairman Carter, for bringing us
together on this important hearing. And today we will hear from
a diverse panel about existing and emerging drug threats that
are infiltrating our communities. Thank you to all of the
witnesses for joining us today to talk about this.
Unfortunately, most Americans have a family member, as we
have before us today, a friend, or a neighbor who has been
impacted by illicit drugs. This could include anything from
opioids such as heroin, illicit fentanyl, fentanyl-related
substances, to stimulants such as cocaine and methamphetamine.
We have all heard heartbreaking stories--and we are going
to hear today--which are truly heartbreaking, about the toll
that illicit fentanyl and fentanyl-related substances are
having on our communities, and the rate at which Americans are
dying from fentanyl poisoning is just staggering. In 2023
alone, the DEA seized over 390 million lethal doses of illicit
fentanyl in the United States. That is more than enough to kill
every American. We have learned that most of the illicit
fentanyl trafficked into the United States is being produced by
transnational criminal organizations in Mexico from chemicals
sourced from China. It is then coming across our southern
border in mass quantities and brought into our communities.
This is why we must work together to finally get the HALT
Fentanyl Act signed into law. The HALT Fentanyl Act sponsored
by our good friend, Rep. Griffith, is on the floor today, and I
encourage all of colleagues on both sides of the aisle to vote
for this. It is vitally important legislation.
On top of the increased presence of synthetic opioids,
xylazine, or tranq, is continuing to emerge as a significant
drug threat. Individuals who use xylazine may be at a higher
risk from suffering from fatal drug poisonings because overdose
reversal medications cannot reverse its effects. There has been
bipartisan interest in making xylazine a schedule III
controlled substance, which will help DEA crack down on
criminals who traffic the substance and hope to continue this
momentum in Congress.
We hear from families every day, families who have lost a
child, a brother, or a sister, and they don't want anyone else
to experience their pain. We owe it to them to do what we can
do to prevent others from experiencing this loss. We should be
working together to punish those who make and import and
distribute these poisons and help those with substance use
disorder find treatment and recovery.
I appreciate the witnesses for being here, and I will now
yield the remainder of my time to my good friend from Florida,
Vice Chairman Dunn.
Mr. Dunn. Thank you very much, Mr. Chair. I am grateful to
be serving as the vice chair of this Health Subcommittee in
this Congress, and as a doctor I look forward to contributing
my expertise for more than 40 years of practicing medicine in
the Army and in private practice to the success of the
committee. I am excited especially to work with Chairman
Carter, and all of my colleagues on the committee, to find
solutions that make the United States the healthiest country in
the world, and that work begins today in this hearing.
Illicit drugs are one of the most serious issues facing the
country, and there are numerous contributing factors to the
opioid and addiction crisis, from open borders to weak-on-China
policies from our prior administration. I would like to
underscore the latter. We are in serious competition with the
Chinese Communist Party, and we have to take seriously what
they are doing to infiltrate our healthcare system.
I thank the witnesses for being here, and I am hopeful that
we can use your unique insights to craft effective policies to
curb this epidemic.
And with that, I yield back.
[The prepared statement of Mr. Guthrie follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Carter of Georgia. The gentleman yields.
The Chair will now recognize the gentlelady from
Massachusetts, Ms. Trahan, for 5 minutes for an opening
statement. For those you who are unaware, there was a coup last
night and the ranking member of the new committee is now
Representative Trahan.
Ms. Trahan. Oh, no, no, no.
Mr. Carter of Georgia. Frank Pallone is history.
Ms. Trahan. Don't get me in trouble.
Mr. Carter of Georgia. Just kidding. Thank you.
OPENING STATEMENT OF HON. LORI TRAHAN, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS
Ms. Trahan. Thank you. Thank you, Chairman. Thank you,
Ranking Member DeGette and our panel of witnesses today.
Today we are discussing existing and emerging drug threats
while one existing and emerging threat--unelected and
unconfirmed billionaire Elon Musk--is creating chaos throughout
the Federal Government. President Trump has handed control of
all Federal funds over to Elon Musk. This is illegal. It is
dangerous.
I ask for unanimous consent to enter into the record a New
York Times article entitled, ``Inside Musk's Aggressive
Incursion Into the Federal Government.'' According to this
reporting, Elon Musk has unilaterally seized control of the
Treasury payment systems which distributes more than $5
trillion in payments annually, including Social Security,
Medicaid, and Medicare benefits. He has no legal authority to
unilaterally seize government payment systems and records nor
the private information of U.S. citizens.
I am extremely concerned by a recent article in the Wall
Street Journal that Elon Musk has now gained access to the
Centers for Medicare and Medicaid Services System which help
facilitate payments and help provide healthcare coverage for
over 160 million Americans. I ask for unanimous consent to also
enter into the record the article entitled, ``DOGE Aides Search
Medicare Agency Payment Systems for Fraud.''
Musk has already gained unlawful access to the personal
information of hundreds of millions of Americans, and now their
healthcare information, what medical conditions they have,
where they receive their healthcare, and what drugs they take.
This is apparently being done by some 20-something-year-old
lackeys of Elon Musk whose identities are being shielded from
the public and who apparently only go by their first names.
Musk and his minions are stealing the American people's
personal information. For what? To benefit his companies? To go
after Trump's political enemies? This is corruption, plain and
simple, and it is utterly bewildering and disappointing that my
Republican colleagues are silent while Elon Musk sifts through
the private data of our constituents. Silence is complicity,
and I urge them to join us in condemning these unlawful actions
and work with us to rein in the Trump administration's actions.
Turning to the topic of today's hearing, our ongoing opioid
overdose crisis. Public health experts and providers know that
we must do more than incarcerate our way out of this crisis.
They implore us to remove barriers to prevention and treatment
programs for substance use disorder in partnership with other
tools to crack down on illicit drug trafficking. For example, a
public health success story is the widespread availability of
the opioid overdose reversal medication, naloxone, and
increasing access to fentanyl test strips are another means of
reducing deaths.
Last week the Trump administration froze virtually all
Federal funding, stealing billions of dollars in funding for
critical opioid prevention, treatment, and recovery programs.
Clinicians have been left wondering if they would receive a
paycheck for their work. Patients have been left worrying about
whether their access to treatment and recovery have been cut
off indefinitely.
The Trump administration halted $6.5 billion in funding for
programs that support a wide range of naloxone programs,
treatment services, and prevention efforts, and it halted
nearly $1.5 billion in funding to conduct research on
substance-use disorder in addition to improving public health.
I am bewildered by statements from my Republican colleagues
about saving lives while there are still real concerns about
Federal funding not getting out the door to help us combat the
drug overdose epidemic.
And Republicans are also looking to undermine our efforts
to combat the overdose crisis as they consider trillions of
dollars in cuts to Medicaid so that they can give tax breaks to
billionaires, like Elon Musk and big corporations.
Medicaid covers nearly 40 percent of all people with opioid
use disorder. Republicans' plan to cut Medicaid will further
limit access to care for substance use disorders, leading to
more deaths. It doesn't have to be this way.
At the end of the last Congress, we negotiated in good
faith with the Republicans on an end-of-year package that would
have reauthorized funding for the SUPPORT Act. This bill funds
opioid overdose programs, first responder training, and
enhances access to substance use disorder treatment. However,
after one tweet from Elon Musk, the House Republican leadership
went back on their promise and tanked the deal. It is clear:
Republicans are not focused at all on addressing this crisis.
Instead they are abdicating their responsibility to Elon Musk.
Thank you. I yield back.
[The prepared statement of Ms. Trahan follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Carter of Georgia. I believe the gentlelady had asked
for unanimous consent to insert in the record two articles.
Without objection, that will be the order.
Mr. Carter of Georgia. This concludes Member opening
statements.
The Chair would like to----
Mr. Griffith. Mr. Chairman, what are the articles on?
Mr. Carter of Georgia. I am sorry.
Ms. Trahan, Representative Trahan, the articles that you
asked to have inserted into the record?
Ms. DeGette. Looks like the New York Times and the Wall
Street Journal.
Mr. Carter of Georgia. Do you want to hold off until you
can look at it?
Mr. Griffith. Yes.
Mr. Carter of Georgia. OK. We will hold off until we can
look at it, and we will move on.
OK. This concludes Member opening statements. The Chair
would like to remind Members that, pursuant to committee rules,
all Members' opening statements will be made part of the
record.
I want to start and thank all of our witnesses for being
here today, taking the time to testify before the subcommittee.
I want to introduce our witnesses now. All of you are
important. Thank you for being here, and thank you for sharing
your stories and your expertise.
Mr. Raymond Cullen, who is a family advocate. Mr. Cullen,
your courage is certainly admirable, and thank you for being
here. We appreciate it very much.
Sheriff Michael Bouchard, the vice president of government
affairs for the Major County Sheriffs Association, thank you
for being here, Sheriff.
Dr. Timothy Westlake, an emergency medicine physician at
ProHealth Care Memorial Hospital.
Ms. Regina LaBelle, professor and director at the master of
science and addiction policy and practice at Georgetown
University. Thank you for being here.
And Dr. Deepa Camenga, the chair of the Committee on
Substance Use and Prevention at the American Academy of
Pediatrics. Thank you for being here.
Per committee custom, each witness will have the
opportunity for a 5-minute opening statement followed by a
round of questions from Members. The light on the timer in
front of you will turn from green to yellow when you have 1
minute left.
I recognize now Mr. Cullen for 5 minutes to give an opening
statement.
STATEMENTS OF RAYMOND CULLEN, FAMILY ADVOCATE; SHERIFF MICHAEL
BOUCHARD, VICE PRESIDENT, GOVERNMENT AFFAIRS, MAJOR COUNTY
SHERIFFS OF AMERICA; TIMOTHY W. WESTLAKE, M.D., EMERGENCY
PHYSICIAN, OCONOMOWOC MEMORIAL HOSPITAL, PROHEALTH CARE MEDICAL
SYSTEM; REGINA LABELLE, PROFESSOR OF ADDICTION POLICY,
GEORGETOWN UNIVERSITY SCHOOL OF ARTS AND SCIENCES; AND DEEPA
CAMENGA, M.D., CHAIR, COMMITTEE ON SUBSTANCE USE AND
PREVENTION, AMERICAN ACADEMY OF PEDIATRICS
STATEMENT OF RAYMOND CULLEN
Mr. Cullen. Thank you, Chairs Guthrie and Carter and
ranking members--I have Pallone, but I----
Ms. DeGette. You need to push that button.
Mr. Carter of Georgia. The microphone.
Mr. Cullen. Can you hear me now?
Mr. Carter of Georgia. There you go.
Mr. Cullen. I am sorry.
Thank you, Chairs Guthrie and Carter and Ranking Members
Pallone and DeGette for having me here today to speak at this
hearing, which, based on the events transpiring this week, is
very timely. I would also like to thank Congressman Joyce for
his support and friendship over the past few years.
I am here today to discuss the fentanyl epidemic which has
been targeting the young people of our country and discuss some
things that we would like to see done so that some other
parents do not receive a visit from the police informing them
that their child is dead.
This is what happened just under 2\1/2\ years ago. The
State police knocked on our door and informed me that our son,
Zachary, was dead, presumably from an overdose. He was the
youngest of our three boys, and he died just 9 days after his
23rd birthday.
Zachary was a wonderful young man who was in college
studying business, had been working at Papa John's delivering
pizzas for 4 years, and was developing a technology company on
the Blockchain platform. That was his dream. That was his
passion. His other love was basketball, especially playing a
game of pickup in the driveway with me and his brothers. His
last year at school his intramural team won the championship,
and he was so excited.
But even more impressive was his kind and compassionate
heart. Zachary helped numerous people during his short 23
years. His last summer at the beach he saved a friend who was
caught in a rip current and on the verge of drowning and held
him up until the lifeguards got there. Another time one of his
coworkers mentioned that he was behind on his rent and was
afraid that he and his family were going to be evicted. Having
just received money from his grandfather at Christmastime, Zach
found out from his manager how much money was needed and
anonymously placed that amount of cash in an envelope and
slipped it into his car. That was our son. He loved his family,
he loved his friends, and he loved life.
Zachary did not suffer from substance use disorder. He was
not an addict. However, following his death, we did learn that
he had used cocaine on occasion at college. We were told that
cocaine is a commonly used recreational drug on campus.
However, Zachary did not die at school. He and a couple of
friends were in Harrisburg celebrating a birthday. We were told
by the detective that they were not in a bad area of town nor
were they seeking out drugs. They were downtown at a few
restaurants and bars eating, drinking, and having fun. The
detective also told us that he believes the boys were targeted
by the dealer. Why we do not know, but they made the decision
to purchase some coke. That, in and of itself, was a poor
decision but not one that should have cost him his life.
Someone intentionally laced that cocaine with fentanyl. Our son
did not accidently overdose. He was poisoned. There is a
difference. Actually, we personally feel that he was murdered.
We beg of you to get the word out about illicit fentanyl to
everyone. This is urgent and must be done immediately because
we know we need to slow down the rate at which other families
are losing their loved ones. We feel this crisis should be
attacked with the same vigor and intensity that COVID was, and
people need to know the statistics. More than 110,000 people
died from overdoses in 2024, and of those, the majority
involved illicit fentanyl. It only takes 2 milligrams of
fentanyl to kill, about the size of 10 to 15 grains of salt.
One packet of Sweet'N Low that is filled with fentanyl is
enough to kill 500 people. Let me repeat that: A Sweet'N Low
packet filled with fentanyl can kill 500 people. So based on
those metrics, the 43 pounds of fentanyl seized coming in from
Canada in 2024 would be enough to kill just under 10 million
people.
Parents need to know that these drugs are not just the ones
being bought on the streets through dealers or from their
child's friends or acquaintances but also through social media
platforms such as Snapchat. Most kids are not addicts. They are
stressed out, depressed, and anxious kids looking for something
to help calm them down, to help them sleep or to help them
focus so they can study. They have no idea that 70 percent of
all drugs bought either from a dealer, a friend, or online are
laced with enough fentanyl to kill them. It is a real-life game
of Russian roulette, and most of them don't even know that they
are playing.
While we understand that there have been some efforts to
combat the scourge, we find it difficult to understand why it
took so long and why combating it would be so controversial or
political.
Some have said there is a stigma attached to those
overdosing on fentanyl, that they are just drug addicts who
will eventually die of an overdose of something at some time.
While Zach did not suffer from substance abuse disorder,
the lives lost of those who were are just as valuable to their
parents and loved ones as Zach is to us.
``So what do you want us to do?'' is the question we have
heard from Members of Congress before. Our answers are, and
have been, education and awareness. We feel strongly for PSAs,
parent-focused on mainstream media, young-adult-focused on
social media. Make fentanyl awareness part of high school
assemblies and college freshmen orientation. And we really need
to distinguish between poisoning versus overdose. The other
side is treatment, access to treatment and rehabilitation
facilities for those already entangled in SUD.
I would like to, once again, thank this body for taking on
such a crucial topic that has forever impacted our lives, our
family's lives, and the lives of hundreds of thousands of other
devastated families as well.
And if you will indulge me, I would like to close with a
prayer that I wrote which was read by my youngest sister at
Zachary's funeral service.
``You have broken me. I am disfigured beyond all
recognition. How can You put me back together with such a vital
piece missing? I will wait.
``And, as if You need any help from me, might I offer the
following: Less artificial anxiety, less wearisome worry, less
insidious selfishness, less foolish pride. And while You are at
it, add more love, add more compassion, add more empathy.
``I get it now, less of me and more of You.
``And one last nonnegotiable. I need the memory of Zachary
Matthew Cullen knit as close to my heart as possible. Period.
Amen.''
I thank you for your time.
[The prepared statement of Mr. Cullen follows:]
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Mr. Carter of Georgia. Thank you, Mr. Cullen.
Sheriff Bouchard, we recognize you for 5 minutes.
STATEMENT OF MICHAEL BOUCHARD
Sheriff Bouchard. Thank you, Chair Carter, Ranking Member
DeGette, members of the subcommittee, thank you for allowing me
to testify today. I am Michael Bouchard, sheriff of Oakland
County, and I represent Major County Sheriffs of America, MCSA,
which includes the largest sheriffs' offices across the
country. Our members collectively serve over one-third of
America's population, and as such, we are on the front lines of
the opioid crisis, the deadliest drug epidemic in American
history.
In 2023, nearly 100,000 Americans lost their lives to
overdose, with fentanyl as the primary driver. The emergence of
synthetic opioids and analogs is worsening the crisis. Law
enforcement, public health officials, and communities need to
have a coordinated, comprehensive response.
In Oakland County, Michigan, where I serve, we are seeing
very concerning new trends. Fentanyl remains a significant
problem as we test these samples in my lab. We have also seen
an alarming rise of xylazine, a potent tranquilizer, and more
cases of para-fluorofentanyl, which is far stronger than
fentanyl. These substances are often mixed with other drugs
like heroin and cocaine, as we just heard, making them harder
to detect and increasing the risk of overdose.
To address these threats, we have been implementing
innovative solutions. We started a crisis response unit. The
team responds to individuals in crisis due to substance use and
mental health issues. We follow up with people that have been
saved from overdoses to connect them to treatment, ensuring
they receive the help they need. We actually did one such visit
and saved a person a second time as he was actively overdosing.
We have also prioritized our coresponder program in
partnership with mental health professionals. We respond to
crisis situations, deescalating and connecting individuals with
appropriate services while ensuring the public safety.
We were the first in Michigan to equip patrol cars with
Narcan, and in 2023 we became the first in the Nation to deploy
Opvee, a Federal FDA-approved nasal spray that can counter
synthetic and nonsynthetic opioids.
Since 2015 through the end of January of this year, my
agency alone has saved 827 lives. That is sad, but it is
important. Every life does matter, and that gives them a second
chance.
Our jail is one of the first in the country to implement a
medically assisted treatment program for incarcerated
individuals struggling with substance use disorder, offering
personal treatment and connecting them to care after release.
We also have a longstanding initiative, like Operation
Medicine Cabinet, which helps prevent prescription drugs by
providing safe disposal sites for used medication as well as
Rides to Recovery, which offer immediate transportation for
individuals seeking help.
But as much as we can do at the local level, law
enforcement cannot do this alone. We need Congress to support
us by passing critical legislation, specifically permanent
fentanyl scheduling. The HALT Fentanyl Act would permanently
classify fentanyl analogs as schedule I substances, helping to
curb the influx of these legal drugs.
Congress needs to reauthorize High Intensity Drug
Trafficking Areas, known as HIDTA. HIDTA is vital for targeting
trafficking routes and dismantling criminal networks. It needs
authorization, increased funding, and continue to be
administered by the Office of National Drug Control Policy.
We need stronger regulations on pill presses. Counterfeit
pills laced with fentanyl are a growing threat. We must tighten
regulations around pill presses and increase the penalties for
their illicit use.
We need more support for reentry programs. Many people
lapse into criminal behavior due to lack of substance use
treatment and support as they reenter society.
We are urging Congress to pass the Second Chance
Reauthorization Act to help former offenders get the treatment
they need.
In many areas, funding for drug enforcement has been
defunded. Congress must provide necessary resources to help us
fight fentanyl trafficking effectively. It is impossible for us
to tackle this crisis without a comprehensive approach that
combines strong law enforcement with effective programming.
Finally, to combat the flow of fentanyl and other illegal
drugs, we need to secure our borders. Strengthening border
security and improving cooperation with law enforcement
agencies will help disrupt the transnational drug trade.
In conclusion, the opioid crisis, particularly the surge in
fentanyl, requires a united and a comprehensive approach. With
your leadership, we can make those significant strides and help
combat drug trafficking, improve public health, and save lives.
I urge Congress to act swiftly, and I thank you for your
attention to these critical issues so that we don't have any
more members to a club no one ever wants to join.
[The prepared statement of Sheriff Bouchard follows:]
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Mr. Dunn [presiding]. Thank you very much, Sheriff.
I now recognize Dr. Timothy Westlake for 5 minutes for his
opening statement.
STATEMENT OF TIMOTHY W. WESTLAKE, M.D.
Dr. Westlake. Thank you, Chairman Dunn, Ranking Member
DeGette, distinguished members of the committee. Thank you for
inviting me to testify and for your leadership.
Before I dive into the topic, I wanted to tell you about
the last time I used Narcan. It was just days ago. It was a
quiet night shift in the ER. I was mulling over my testimony
when I had to rush out to a car that screeched into the
ambulance bay. It was driven by the girlfriend of a patient who
took what he thought was a Percocet. It was actually a lethal
dose of fentanyl. He wasn't breathing and was about to go into
cardiac arrest. We pulled him out and quickly resuscitated him
with Narcan. Within a minute, he went from being blue and
pulseless to wide awake. He was lucky this time and went home
with his family. Far too often the outcome is different.
Fentanyl poisoning deaths are a scourge in this country and
will require all of us working together to solve it.
I want to share my perspective informed by 25 years on the
front lines of emergency medicine and over a decade in medical
regulation and policy work. I was chairman of the Wisconsin
Medical Examining Board, led the Wisconsin prescription opioid
reform strategy, and originated the idea of fentanyl class
scheduling. I see lethal drug vats as a fire hydrant with many
spigots. They include, but are not limited to, prescription
opioids, xylazine, nitazenes, illicit fentanyl, and fentanyl-
related substances, or FRSs. Different tactics and strategies
may be needed to be deployed to shut down each of the spigots.
Unfortunately, when one is shut down, either another one gets
more powerful or a different one opens up.
I would like to clarify what FRSs are and why permanently
scheduling them as a class is a critical policy tool. FRSs are
highly active opioids almost identical to fentanyl except for a
tiny difference in their chemical structure created by changing
a single ingredient during synthesis. The result of this tweak
is a new potent opioid with the same deadly effects as
fentanyl, and without class scheduling would be legal until
causing numerous deaths.
Class scheduling simply removes the incentive to create new
FRSs and has been proven to do what it was designed to do: halt
their very creation. Some who oppose class scheduling point to
deaths from illicit fentanyl as proof it doesn't work, but that
is a misunderstanding of the facts. FRS scheduling does not
address illicit fentanyl. It was never intended to do so. There
is no quick or easy solution to the scourge of illicit
fentanyl, but the solution to the spigot of FRSs is a simple
legislative fix. It is one the House is considering this week
and voting on this afternoon, the HALT Fentanyl Act.
If schedule I penalties were removed for FRS trafficking,
like some have proposed, it would reincentivize their creation
and significantly weaken the law's most powerful proactive and
preventative effects. There is a time and a place for criminal
justice reform, but FRS scheduling is not it.
Some suggest FRS scheduling would have a negative impact on
research. While theoretical, it has been addressed with
stakeholder input and is supported by the very agencies and
organizations representing academic scientific research,
including the NIH, HHS, FDA, and the National Institutes of
Drug Abuse. The HALT Fentanyl Act would significantly loosen
restrictions into studying all schedule I substances, not just
FRSs, and open up promising areas of research into substance
abuse.
Let me also speak about the threat of nitazenes. They are
opioids as deadly as fentanyl. They have recently been
implicated in hundreds of deaths across the country, emerging
as the new spigot that opened up after FRS class scheduling was
implemented.
Since 2020, DEA has scheduled 10 different bioactive
nitazenes and, due to the creation of new variants, has
encountered and is in the process of scheduling multiple
others. This is eerily reminiscent of what we saw with FRSs 10
years ago prior to class scheduling. I support working with DEA
and taking a closer look at implementing class scheduling for
nitazenes due to their extreme lethality.
Xylazine is a potent animal tranquilizer and sedative used
in cattle and horses that has not been scheduled federally, and
can currently be bought legally online. It is used in
veterinary medicine only and not approved for use in humans. It
is often combined by cartel chemists with illicit fentanyl in
order to amplify sedation and euphoria but also causes strong
respiratory suppression, increasing overall overdose risks and
lethality. There is an urgent need for Federal legislation to
control it and to protect the public.
It is time for common sense to prevail and for Congress to
take action, pass the HALT Fentanyl Act, and permanently close
the spigot of FRSs. You cannot die from ingesting something
never created, nor can you be incarcerated for trafficking
something that does not exist. That is the beauty and
simplicity of FRS class scheduling.
Thank you again, and I look forward to answering all of
your questions.
[The prepared statement of Dr. Westlake follows:]
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Mr. Dunn. Thank you, Dr. Westlake.
I now recognize Ms. Regina LaBelle for 5 minutes for an
opening statement.
STATEMENT OF REGINA M. LaBELLE
Ms. LaBelle. Chairman Dunn, Ranking Member DeGette, and
members of the subcommittee, thank you for the opportunity to
testify today on this important topic.
I am Regina LaBelle. I am professor of addiction policy at
Georgetown University. There I direct the master of science and
addiction policy and practice, and the Center on Addiction
Policy at Georgetown Law's O'Neill Institute. I am really
pleased to be joined here today by some of my students who are
here to learn how to develop a bipartisan approach to reducing
overdoses and improving the lives of people who have substance
use disorder, or who are affected by addiction. I also serve on
the National Advisory Council on Drug Abuse at the National
Institutes of Health. However today, I speak to you in my
personal capacity.
So for over 15 years I have worked on drug policy in both
government and at Georgetown, and I have seen bipartisan
efforts lead to meaningful action. And I have also seen
firsthand the impact of the overdose crisis. The grieving
families who have lost loved ones remain always present in our
mind as we work on these issues. I have also celebrated with
those in recovery, witnessing the power of resilience, strong
support systems, and effective policies.
And we know that, since 2000, over 1 million Americans have
died from overdoses, and recent data from August of 2023 to
August of 2024 shows a 20 percent decrease. This is still
unacceptably high. Overdose deaths are still increasing among
Black, indigenous, and Hispanic communities, and the majority
of these deaths as we are talking about today involve synthetic
opioids like fentanyl often mixed with dangerous substances
like xylazine. So obviously, you have to take decisive action
on this issue.
Addressing the threat of synthetic drugs requires a
comprehensive strategy. First, transnational efforts,
strengthening law enforcement cooperation to disrupt
transnational criminal organizations. Illicit fentanyl is
manufactured using precursor chemicals from China and processed
in Mexico and then transited into the United States. Disrupting
these supply chains requires international collaboration,
counternarcotics cooperation, and aggressive prosecution of
financial crimes that sustain the drug trade.
Public health, expanding access across the continuum of
care, prevention so that we can equip parents and communities
with the tools to recognize early signs of mental health and
substance use, expanding access to naloxone that saves lives.
So we know that States like Tennessee have documented over
103,000 overdose reversals through naloxone distribution.
Federal investment in evidence-based treatment that
includes medications for opioid use disorder is essential, and
Congress took an important step by passing in a bipartisan
manner the Mainstreaming Addiction Treatment Act. It removed
outdated barriers to medication access, but more work obviously
is needed.
And our criminal justice system is part of the solution.
The Federal approval of Medicaid 1115 waivers allows States to
use Federal Medicaid matching funds to treat people before they
are released from a jail or prison, and this improves reentry
outcomes.
The workforce, investing in workforce and identifying,
tracking emerging drug threats. So we have to equip our public
health and law enforcement agencies with the ability to detect
and respond to new synthetic drug threats. States like Rhode
Island and North Carolina are leading the way with drug
monitoring programs that identify emerging substances and issue
public health alerts.
Continued support for the Federal workforce, including CDC,
State Department, the Drug Enforcement Administration, and the
Office of National Drug Control Policy is also critical to
ensuring a whole-of-government response.
The best way to address this issue is through an all-of-
the-above strategy, and one that integrates law enforcement,
public health, and the workforce investment. By working
together, we can disrupt illicit drug supply chains, expand
treatment and recovery services, and look around the corner so
we are prepared for the next emerging threat.
This is a bipartisan issue, and it affects every one of our
communities, and solutions have to be pursued with urgency and
unity.
Thank you very much for your time and commitment to
addressing this epidemic.
[The prepared statement of Ms. LaBelle follows:]
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Mr. Dunn. Thank you, Ms. LaBelle.
I now recognize Dr. Camenga for her 5-minute opening
remarks.
STATEMENT OF DEEPA CAMENGA, M.D.
Dr. Camenga. Good morning, Chairman, Ranking Member
DeGette, and members of the subcommittee. Thank you for the
opportunity to be here today to discuss the impact of current
and emerging illicit drug threats on children, adolescents, and
young adults.
My name is Dr. Deepa Camenga, and I am chair of the
American Academy of Pediatrics' Committee on Substance Use and
Prevention. Today I am here representing the AAP, a nonprofit,
professional medical organization representing over 67,000
pediatricians.
As a physician board certified in pediatrics and addiction
medicine, I have spent nearly 20 years caring for teens. I
provide primary care and also care for young people who have
overdosed, have opioid use disorders, or who have started to
try to use alcohol and drugs. I am experienced in prescribing
medications for the treatment of opioid use disorder and
conduct research on adolescent substance use prevention and
early interventions.
Today, I will talk about the importance of focusing on
teens when addressing the ongoing overdose crisis, the role
pediatricians play in prevention and treatment, and offer
suggestions on how we can make progress with the help of
Congress.
Every day, pediatricians see how the illicit drug epidemic
harms young people. Today's adolescents are growing up amidst
the most potent and lethal illicit drug supply in human
history. The science is clear: Trying substances during
adolescence increases the risk of addiction due to ongoing
brain development during this period. The widespread
contamination of the drug supply with fentanyl, the emergence
of counterfeit pills, and the low availability of treatment for
teens, are continuing to fuel the opioid overdose and poisoning
crisis.
Some of the most important things we can do today are to
prevent young people from illicit drug exposure and to treat
teens with substance use disorders. Pediatricians are an
essential workforce for delivering prevention interventions and
recognizing the early signs of substance use.
I would like to describe some of the way pediatricians
today are addressing the illicit drug epidemic in the
healthcare setting.
First is through screening, brief intervention, and
referral to treatment. For some young people, a pediatrician
may be the first person to provide accurate information about
the potential harms of substances. SBIRT is an evidence-based
approach that we use in our offices. We use validated screening
tools, brief counseling techniques, and refer teens with
substance use disorders to treatment. Unfortunately, in many,
many communities this treatment is very hard to find.
Second, it is by talking to patients and their families
about naloxone and prescribing it for overdose prevention.
Third is by linking patients and family with community-
based prevention programs.
And finally, pediatricians help young people receive
evidence-based treatment. The AAP recommends buprenorphine for
the treatment of opioid disorder. Of note, adolescents with
opioid use disorder often need mental health treatment
alongside lifesaving medications. Integrating behavioral health
into primary care helps young people receive these treatments.
Congress has an important role in strengthening access to
evidence-based prevention, early intervention, and treatment. I
will share four of AAP's core recommendations.
First, Congress can take up legislation to ensure private
health insurance, Medicaid, and publicly supported substance
use services stay in place and better support youth prevention,
early intervention, and treatment needs.
Second, Congress can provide funding for workforce
development and training so pediatricians and other people who
work with young people can better meet the demand for care in
their communities.
Third, Congress can incentivize the creation of integrated
behavioral health models, strengthen payment, and eliminate
barriers to integrated care.
And finally, Congress can expand broad-based prevention
programs, support public health campaigns to educate about the
risks of counterfeit pills and fentanyl, and bolster drug-use
monitoring and surveillance efforts like the Youth Risk
Behavior Survey. Healthcare professionals need access every day
to this vital data and research to respond to current and
future drug threats efficiently and swiftly.
Thank you for the opportunity to testify today. I look
forward to answering your questions and working with you to
protect young people from the current and emerging drug
epidemic.
Thank you.
[The prepared statement of Dr. Camenga follows:]
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Mr. Carter of Georgia [presiding]. Thank you, Dr. Camenga.
And thank you, all of you, for your testimony. We appreciate
it.
We will begin now questioning, and I will recognize myself
for 5 minutes.
Again, thank you all for being here. Thank you for your
testimony. We all understand what is going on here. We have got
a poisoning problem here in America. I won't bother to inundate
you with all of the facts and figures. We all know what is
going on. Customs and Border Protection seized more than 21,000
pounds of fentanyl at our borders and enough fentanyl to kill 4
billion people.
I do want to share a personal story with you.
Professionally, I am a pharmacist, and I was at a town hall
meeting, and I was addressing that town hall meeting, and we
were talking about fentanyl. And we were talking about the
problems that we are having, and I made a mistake. I referred
to it as fentanyl addiction. And a mother stood up, and she
corrected me--as she should have--and she said, ``No, sir, it
is not fentanyl addiction.'' She said, ``It is fentanyl
poisoning.'' She said, ``My son took one pill, and he is dead.
That is poisoning.''
She was right, and I was wrong. It is fentanyl poisoning,
and it is a problem. It is a serious problem, a leading cause
of death for Americans between the ages of 18 and 45. And
everyone in this room, whether you are up here on this dais or
whether you are out there in the audience, everyone in this
room knows someone or has a family member who has been impacted
by this. Everyone here has.
Folks, we have got to do something about this.
Sheriff Bouchard, I wanted to ask you: Do you recognize
individuals who die because of fentanyl poisonings as victims
of a crime?
Sheriff Bouchard. Thank you, Mr. Chair.
Yes, we actually have prosecuted successfully individuals
for murdering the individuals that they supplied the drugs to
in the past.
Mr. Carter of Georgia. Thank you for that.
And, you know, we know that the opioid epidemic is still
negatively affecting too many Americans, but we are encouraged
that the numbers are going down, and we are encouraged that we
are making progress, and that is important. However, we can't
stop. We can't stop until we completely eradicate this.
We also know that fentanyl remains a threat as it crosses
the border of millions of Americans, and that naloxone, that is
now available over the counter--I have got to share this with
you. I am often critical of the FDA--as I think I should be--
but I do applaud them for making naloxone over the counter. We
wrote a letter asking them to do that, and they responded, and
they did do it, so kudos to them. It ought to be available. I
have said all along it ought to be just like fire
extinguishers, and wherever you see a fire extinguisher, you
ought to see naloxone available. I carry it in my backpack
everywhere I go. Thank God, I have not had to use it, but I
have got it if I need it. It is a lifesaving drug. And we need
to have it.
Sheriff Bouchard, what role do you see for naloxone in
protecting those who are interdicting illicit drugs as well
with Americans?
Sheriff Bouchard. Well, we are on the front lines. We are
typically the first to receive the call. Typically we often
beat the medical providers as well, and so it is important for
us to have the tools to be able to save that life in those
critical moments. It actually took me almost 2 years to get our
State legislature to allow us to even carry and use Narcan at
the time, and now we have added Opvee to our tool chest as well
because we are seeing such strength in the synthetic realm that
sometimes it takes three, four, and five doses, and Opvee has
allowed us to have that extra tool that has reversed some of
those. So the front lines is really what we are seeing.
Mr. Carter of Georgia. OK. Dr. Westlake, would you agree?
Dr. Westlake. Absolutely.
Mr. Carter of Georgia. OK. You know, there was a December
2024 DEA report that found that more than 107,000 people lost
their lives due to drug overdoses in 2023, with nearly 70
percent of that being attributed to opioids such as fentanyl.
Naloxone saves lives. We have been able to get some of the
companies, some of the manufacturers to donate it, and we have
been sending it to schools and making sure that they have it.
Naloxone should be in every school in America. Every school in
America should have naloxone. It should be available.
Dr. Westlake, what steps would you take to increase access
and awareness of a lifesaving drug like naloxone?
Dr. Westlake. Well, I think the key is for a lot of the
interventions necessary in this space is through education, and
I think a lot of that has happened already. I mean, when I
started the work in opioid prevention awareness 10 years ago,
it was very little of it around, and now it seems to becoming a
thing that is much more acceptable and understood. And I think
a lot of physicians--I, myself, in the ER, prescribe it when I
send someone home after an opioid----
Mr. Carter of Georgia. We are getting rid of that stigma?
Dr. Westlake. Exactly.
Mr. Carter of Georgia. And it is safe. You can use it. You
are not going to hurt somebody with it.
Dr. Westlake. Exactly. I never understood why it was
controlled before, why you needed a prescription to use it.
Mr. Carter of Georgia. Exactly. Good. Well, again, thank
all of you for being here. Appreciate this very much.
And I will yield, and now at this time I will recognize
Ranking Member DeGette for 5 minutes of questioning.
Ms. DeGette. Thank you so much, Mr. Chairman. And just to
let you know, I carry naloxone in my car in Denver and have for
quite some time.
Mr. Cullen, I just want to say to you on behalf of every
single Member of Congress up on the dais, thank you for coming
today and sharing your story and your picture of your beloved
son, Zachary. All of us are committed to ending this scourge,
and we want to work together to do it.
Ms. Cullen. Thank you.
Ms. DeGette. Mr. Chairman, I want to talk some more,
though, about what has been going on because I think this
relates to whether we can all--whether we really are committed
to taking this all-of-the-above approach.
On Tuesday, January 2l, HHS Secretary Dorothy Fink sent a
memorandum to HHS employees directing a communications freeze.
And then on Monday, January 27, the Office of Management and
Budget sent a memorandum across the executive branch directing
a funding freeze. Now, this OMB freeze would have frozen a lot
of the programs that our panelists have been talking about here
today, naloxone programs, treatment programs.
Dr. Camenga--is that how you say it--you said in your
testimony four things that we needed to expand and do. All of
those things, the existing programs in those areas all would
have been frozen in this OMB judgment. You are nodding. Does
that mean you agree?
Dr. Camenga. Yes, I agree.
Ms. DeGette. Yes. So all of those things would have been
frozen. Now, thankfully, the U.S. District Court in the
District of Columbia and Rhode Island granted temporary
restraining orders of the freeze on Federal disbursements and
OMB rescinded the order, but it is still having impacts. For
example, Colorado's State Office of Rural Health told me
earlier this week that the critical grant funds that they
usually get the first or second day of the month still hadn't
come through. You are also nodding to this. Have you seen
experience with this, these kinds of funds as well, Doctor?
Dr. Camenga. I am hearing that in my local community as
well, in towns that people are not able to do their jobs and
are kind of confused as to what is going on.
Ms. DeGette. People are not able to do their jobs doing
what?
Dr. Camenga. Helping people get to treatment, helping
people give treatment to others.
Ms. DeGette. So as a result of this Trump-Musk freeze,
people who are supposed to be doing drug treatment programs are
not able to get their resources. Is that right?
Dr. Camenga. That is a possibility.
Ms. DeGette. OK.
Dr. Camenga. I have been hearing anecdotally that.
Ms. DeGette. You have been hearing it?
Dr. Camenga. Yes.
Ms. DeGette. Yes. And my people are telling me that too.
Ms. LaBelle, I want to ask you, you serve on the National
Advisory Council on Drug Abuse, is that right?
Ms. LaBelle. Yes.
Ms. DeGette. Now, what is the function of that advisory
council?
Ms. LaBelle. So we have final signoff on grants that are
going out to researchers nationwide above a certain amount of
money.
Ms. DeGette. OK.
Ms. LaBelle. And it is the end of a long process.
Ms. DeGette. Now these are grants in drug treatment?
Ms. LaBelle. They are grants for a number of areas of drug
treatment.
Ms. DeGette. And when was the most recent meeting of that
advisory council supposed to take place?
Ms. LaBelle. So we were supposed to have a meeting on
Tuesday and----
Ms. DeGette. What happened about that?
Ms. LaBelle. I received an email at 8:00 a.m. saying it was
canceled.
Ms. DeGette. And do you know why it was canceled?
Ms. LaBelle. We were not given a reason.
Ms. DeGette. And do you know when it is going to be
rescheduled?
Ms. LaBelle. We have not heard anything.
Ms. DeGette. What is the impact of that advisory council
not meeting?
Ms. LaBelle. Well, it will delay sending out these needed
research dollars to researchers who can do good work on many of
the issues we are talking about.
Ms. DeGette. And what are they researching?
Ms. LaBelle. They are researching what treatment works.
They will research how to use naloxone better. All of those
types of things are funded by the Federal Government.
Ms. DeGette. So that is not happening now because the
meeting was canceled?
Ms. LaBelle. At this time there is a delay on it, right.
Ms. DeGette. Thank you.
Now, in the conclusion to your written remarks, you say the
best approach to addressing synthetic drug treatment is an all-
of-the-above strategy, one that integrates law enforcement,
public health, and workforce investment.
I just want to ask you: Does simply rescheduling fentanyl
without doing all of the rest of the things you talked about
going to have a significant impact on reducing this crisis?
Ms. LaBelle. There is no one answer to this, and I think we
can all agree to that.
Ms. DeGette. OK. Now, one last--I have one last thing, and
that is, I want to close to say I am disturbed that we are
having this hearing when Republicans failed to live up to a
bipartisan, bicameral agreement to reauthorize and strengthen
the Support for Patients and Communities Act. This is why I
asked you, Ms. LaBelle, this question, is because we need a
comprehensive approach. And I said this the other day in the
Rules Committee when we talked about this bill coming up: Just
rescheduling fentanyl is not going to solve the problem, but
what is really going to worsen the problem is when the Trump
and Musk administration freezes the resources to go out, the
training, the research dollars.
I hope we can all work together to make sure this never
happens again. And I yield back.
Mr. Carter of Georgia. The gentlelady yields. The Chair now
recognizes the chair of the full committee, Representative
Guthrie from Kentucky, for 5 minutes of questioning.
Mr. Guthrie. Thank you, and recalling Dr. Westlake's
testimony before, scheduling illicit fentanyl, it doesn't solve
all the problems. But absolutely your testimony before was it
does solve the problem of illicit fentanyl, and being able to
schedule it. So it is part of the fight that we have against
these drugs coming into our country.
And speaking of that, Sheriff Bouchard, I have said earlier
that we had enough doses of fentanyl to kill Americans captured
last year. Thirty-seven percent of that was found to be laced
with xylazine as well.
In April of 2023, the Office of International Drug Control
Policy designated fentanyl adulterated with xylazine as an
emerging drug threat that indicated that people who ingest
fentanyl mixed with xylazine may be at higher risk of suffering
deadly drug poisoning because it is not reactive to Narcan and
the others that we have seen.
So, Sheriff Bouchard, how can Congress and our Federal
partners be more proactive about combating emerging drug
threats before they have infiltrated our communities in mass
quantities?
Sheriff Bouchard. Thank you, Mr. Chair. As the doctor
mentioned, you know, scheduling or blocking the things that are
being developed, it is important for us to be nimble because
what they typically do as soon as you schedule very--with
specificity, a particular kind of drug, then they change one
component in the lab, and then it begins to be mailed in.
In fact, I talked to our narcotics commander by email last
night, and he said we are having a huge rise in the amount of
things that coming via postal and other package ships--
companies across the country are coming in via that. They
changed one thing, and then it is no longer illegal. Xylazine
is an example. I have been trying for almost a year and a half
to get that scheduled in my State. And we are seeing huge
numbers of that in my lab in all of the different samples that
we're testing in other kinds of drugs.
Mr. Guthrie. So in the last hearing we had--but mine isn't
the same as Dr. Westlake, but it is testimony that is still in
my mind, and I don't think it will leave my mind--we had
someone from the administration, the last administration in
DEA, that said that they didn't want to schedule this as
fentanyl because they wouldn't--what if--they need to check it
every time it changes because what if it's as safe as water?
Have you ever seen any fentanyl, illicit fentanyl, that
showed up in our country that is safe?
Dr. Westlake. No, to date, as far as substances that have
been encountered by law enforcement, every single one has been
bioactive--most of them as potent as fentanyl, one of them is
7,000 more times potent than morphine. So there have been no
bioactive fentanyl-related substances encountered today.
Mr. Guthrie. And his point--he didn't use that example--his
point was if it has been adulterated, how do we know it has got
less safe--and he said safe as water--or more safe, or could be
essentially placebo. Or could it be more deadly? But my point
in scheduling this, people aren't sending stuff less deadly
into the country.
I guess they could have fought--gone that direction, but I
don't think that is why they sent it in here, to give up
placebo.
So, Dr. Westlake, whatever takes someone down in this
situation where they have substance abuse disorder issues,
whatever starts that pathway is sad, and it is something we
want to address.
But just, specifically, I had a case of a mom back home in
my district that had lost her daughter. It was a soccer injury.
She had ACL surgery and then becomes--as far as she knew, that
is what led to her substance abuse disorder, from routine
prescription from surgery.
And so we just saw the other day there is a new class of
pain medicine that has been approved for nonopioid pain. So
hopefully we can get there. And it has been a bipartisan effort
to get to that.
And so my question is, in your experience, can opioid
exposure after an injury or surgery lead to misuse of
prescription? Comment on what I just said about that. And then
is it important for physicians to have--to try to stay away
from opioids and go these new class of drugs when they become
available?
Dr. Westlake. Yes, that is a great question, Chairman.
There is a study out of University of Michigan that shows that
one out of 16 kids that are exposed for the first time to
Vicodin or hydrocodone after wisdom tooth surgery are using it
a year later.
So when I explain this to parents when they have a 20-year-
old that come in with a wrist fracture, that I am not going to
be prescribing hydrocodone because there is a 1 in 16 chance
that they will still be on it and become addicted. And that is
the pathway to this, I think, this fentanyl crisis that we are
seeing now. Fentanyl poisoning is the initial opioid
overprescribing that happened.
I think we have addressed that in medicine, in-house
medicine. I think, you know, in Wisconsin we implemented the
reforms and gave the physicians the tools and strategies.
Mr. Guthrie. In just a few seconds, what about this new
drug? What do you think? I just have a few seconds left.
Dr. Westlake. It is fantastic. I mean, there is a study
that shows----
Mr. Guthrie. Is it as effective as opioid?
Dr. Westlake. From what I understand, yes. It is brand new.
Mr. Guthrie. OK. Thanks. I am out of my time, it has
expired. I appreciate your time. And I will yield back.
Mr. Carter of Georgia. The gentleman yields. The Chair now
recognizes the gentleman from California, Dr. Ruiz, for 5
minutes of questions.
Mr. Ruiz. Thank you very much. And thank you to the
witnesses for being with us today for this important
discussion.
It continues to be mind-boggling to me that we are having
this hearing today while the Trump administration continues to
dismantle the very systems that exist to combat the opioid
epidemic.
For example, the Substance Use Block Grant administered by
SAMHSA is the cornerstone of States' prevention, treatment, and
recovery systems. It gives States the flexibility to tailor
their services to meet the needs of the populations in their
States.
The most recent data shows that this block grant allowed
over 1.6 million people to access treatment. Now this crucial
source of funding is endangered, and access to treatment is
being jeopardized all because of the Trump administration's
absurd power grab.
Ms. LaBelle, thank you for sharing your testimony with us
today and for your expertise. I have several questions for you.
What impact would a wide-reaching Federal funding freeze have
on Federal, State, and local efforts to combat the opioid
epidemic?
Ms. LaBelle. Well, it would be devastating to States,
certainly, and local governments. The grant program you
mentioned is the number one source of funding for prevention in
every single State in the country. That leaves a huge gap.
Mr. Ruiz. OK. And can you provide examples of how
administrative actions like this hamper both upstream and
downstream approaches to combating illicit drugs?
Ms. LaBelle. I mean, I mentioned the research piece, which
is very important. I also think I want to emphasize how
important it is that we have a trained workforce. And, you
know, a lot of Federal workers are kind of in limbo right now.
We need to bring people in, not only retain the people who are
good at their jobs, who do a good job across the continuum and
work in law enforcement, but also make sure that they have the
skills and ongoing training that they need to address this
issue.
Mr. Ruiz. We heard just yesterday in a news article in VPN
news entitled ``Virginia Community's Health Centers Close Over
Federal Funding Access'' as a result of President Trump's
funding freeze that 16 Federal qualified house centers in
Virginia have been unable to access Federal funding. And many
are closing their doors.
Mr. Chairman, I ask unanimous consent to insert this
article into the record.
Mr. Carter of Georgia. Are we OK--we will look at it.
Mr. Ruiz. Yes, it is right there. Usually, it is custom to
just accept it into the record.
Mr. Carter of Georgia. I understand. We didn't have it
beforehand, though, so we are just going to look at. We will be
right back with you.
Mr. Ruiz. OK.
Ms. DeGette. I can see why you guys might not want to put
it in. It criticizes the administration.
Mr. Ruiz. I will get back to my----
Mr. Carter of Georgia. We will look at it.
Mr. Ruiz [continuing]. Time. And just--you know, Tuesday at
the Rules Committee hearing, my colleague, Mr. Griffith, said
while, quote/unquote, ``inartful,'' these administrative
actions were necessary for the incoming administration.
So with all due respect to my friend, the gentleman from
Virginia, I am not sure that people in his district who are
served by two FQACs that closed and now must drive miles upon
miles, even up to 2 hours, for care will think that these
actions are inartful, but just downright harmful and costly.
Ms. LaBelle, what unique role do FQACs play in combating
substance abuse disorders in rural and underserved communities.
And how will closing them as is done in Virginia impact
partnerships between law enforcement, providers, and patients
trying to get appropriate care?
Ms. LaBelle. Yes, it affects--the FQACs are a critical
component of the healthcare continuum for people in rural
communities, in particular. And it is the place they can go to
get the type of services that they need to address their
substance use disorder. And without those, we could see
increased overdoses.
Mr. Ruiz. In fact, we have discussed here previously during
the Republican effort to dismantle Medicaid as we know it that
70 percent of those who seek treatment for opioid use disorder
use Medicaid.
And so dismantling block granting, limiting Medicaid, and
attack on Medicaid also reduces access to care. Reducing access
to care, either through funding freezes or going after
Medicaid, makes Americans unhealthy again, and it raised costs
for everyone.
Mr. Chairman, I think the points made here by the witnesses
point out the hypocrisies in the President's actions and the
real impact on the tools our Nation needs to stay ahead of bad
actors and protect our communities. Thank you, and I yield
back.
Mr. Carter of Georgia. The gentleman had asked for--the
gentleman yields, and he had asked for an article to be
inserted into the record. Without objection, it is approved.
[The information appears at the conclusion of the hearing.]
Mr. Carter of Georgia. The Chair now recognizes the
gentleman from Virginia, Mr. Griffith--OK. The gentleman, Mr.
Griffith, from Virginia is recognized for 5 minutes.
Mr. Griffith. I appreciate that, and I am hopeful that my
team has given three letters that I would like to submit for
the record to our friends on the other side of the aisle. But
if not, I will certainly tender those so they can take a look
at them. But I would ask unanimous consent for these three
letters to be introduced. One letter is spearheaded by
neurosurgeons, anesthesiologists, pain physicians, spine
doctors, orthopedic surgeons, and others. These physician
organizations have been great stewards of the Controlled
Substances Act and mentioned that the temporary scheduled
classification of the illicit analogs is not a sustainable or
rational approach. In other words, not doing it temporarily is
not rational.
The other two letters are support letters from law
enforcement agencies and urge passages of the HALT Fentanyl
Act. So after our colleagues have had a chance to take a look
at that, I would ask for unanimous consent.
That said, let me also set the record straight on something
that was just said. And while it is of concern that health
centers in Virginia may have closed, my understanding is all
that is getting worked out. But further it was said that two in
my district had closed. That is not accurate. And I just want
to get the record straight.
We have been monitoring that situation. One of my health
centers did report that they had had some difficulty accessing
a site, but it did not cause closure. And we believe that they
should have that resolved shortly. But no closure had resulted
that I am aware of in my district. And so if somebody has
better information, please provide it to me.
Dr. Westlake--and then, Sheriff Bouchard, I am going to
come to you--I am switching gears from what I was talking
about. So I have concerns. My wife is a juvenile domestic
relations district judge in the Commonwealth of Virginia, she
is seeing concerns. So I want to know what your concerns are in
your lines of work about the impact of unregulated,
intoxicating hemp products on our kids. And a followup would
be, what do you think we need to do to create a regulatory
framework to allow lawful products to come to market? I have
been working with the FDA on that, so I have got some ideas
there. But I just want to know what you all have seen about
these unregulated, intoxicating hemp products on our children.
Sheriff Bouchard. We have not seen a huge number of hemp
products now since we have legalized marijuana in our State.
But what we have seen is an adulteration of marijuana products,
and prior to that hemp, with other kinds of synthetics and
other kind of drugs, like fentanyl. So we have actually found
outside of our supply chain, if you will, the legal supply
chain of marijuana in our State, illegal marijuana has been
tampered with and has fentanyl in it. And so, we have seen all
of these things really need a regulated, inspected process. And
I would encourage that to happen both with hemp and with
marijuana.
Mr. Griffith. Let me do a followup before I go to you, Dr.
Westlake. Let me just do a quick followup. So one of the
problems we have seen in our region is THC gummy bears, or
gummy bears that are supposed to have CBD, and then there is an
unregulated, unknown amount of THC in there. And kids get ahold
of them and they think they are candy, and then they overdose.
And then when I say overdose, I am not talking about deaths at
this point, but there may have been some indications, there may
have actually been some brain damage. Are you all not seeing
that in your region? Is that just a Virginia problem?
Sheriff Bouchard. No, no, we are actually seeing that as
well. In fact, there's PSAs in our region and among a number of
States that have legalized marijuana and components like
gummies, advising kids and parents about that and how to store
it and the dangers of it. And there's some discussions about
trying to make some of these gummies not look like little
characters that attract the kid or the packaging that attracts
children because they think it might be candy or it might be
vitamins but, in fact, it has a drug component.
Mr. Griffith. And it really would be helpful for you to get
guidance from the FDA, wouldn't it?
Sheriff Bouchard. Yes, sir.
Mr. Griffith. Dr. Westlake, the same questions.
Dr. Westlake. Great. I personally saw some marijuana
poisonings last week from gummies. I have seen it in the past,
and two or three episodes last week alone. It is illegal in
Wisconsin but comes up from Illinois and from Michigan and from
around.
The other part we see is the fentanyl-laced marijuana. I
have had overdoses from that. And we are also seeing that with
what you are talking about with, like, CBD that is unregulated.
People come in and they don't know what is going on, and it
turns out that they are intoxicated from marijuana that they
thought they were just taking because there is no quality
control or oversight over that.
Mr. Griffith. All right. I appreciate that.
Dr. Westlake, can you--I am switching back now to HALT
Fentanyl--can you explain, because we have heard about
scheduling side--and there is some disagreement on that? I
really like the part--of course, so it is my bill, so it is
natural I would like for it to have--but I like the part that
allows for research to go on almost 4,800 estimated analogs or
fentanyl-related substances. Can you tell us what you think
about that, and how you think that we ought to go forward with
that?
Dr. Westlake. Yes, I think it is a huge--and thank you for
your leadership on the bill. It is a huge benefit to have to
open up schedule I research. I think there has not been a lot
of schedule I research on schedule I drugs because of that. So
this will be a huge boom to that. And that is why it was signed
off on by NIH and HHS and FDA.
On here, there are some initial concerns about whether it
would be too restrictive. But because of the way we design the
language, it really has only affected those that are
bioactively, you know, would structure relationships
bioactively, likely to be active.
Mr. Griffith. I really appreciate it. It is part of why I
really like the bill. I yield back.
Mr. Carter of Georgia. The gentleman yields back. The
gentleman had asked for three articles to be inserted into the
record. Without objection, that will be the order.
[The information appears at the conclusion of the hearing.]
Mr. Carter of Georgia. Can I have Members' attention for
one second? Y'all please try to get these to us before the
meeting so that we don't have to be interrupted with this and
don't have any controversy about it. OK? Thank you.
At this time, the Chair will recognize Representative
Dingell for 5 minutes of questioning.
Mrs. Dingell. Thank you, Mr. Chairman. The opioid epidemic
has ravaged families across the country, and quite frankly, has
touched many of us, if not all of us, personally. It is an
issue that requires serious bipartisan attention, and we have
to work together because we know too many people are dying of
it.
Mr. Cullen, I join my colleagues in thanking you for having
the courage to tell your personal story.
I want to start by thanking Sheriff Bouchard for being here
with us today. Mike has been a friend for a decade. John James
and I both share him. He is the sheriff in my district. But
more importantly, when my sister died of a drug overdose and I
didn't understand it, I didn't understand what was in her
blood, I didn't understand how she got it, where it came from,
was there something more that I can do--Mike Bouchard was there
for me. So I have lived this personally with the sheriff that
is with us today.
Sheriff Bouchard, the drug chemistry section of Oakland
County's Forensic Science Laboratory analyze samples submitted
by various law enforcement agencies for controlled substances
and illegal drugs. I introduced legislation to reauthorize the
SUPPORT Act's lab pilot program to improve coordination between
public health laboratories and those operated by law
enforcement to better detect fentanyl and other synthetic
opioids.
Can you tell us more about the Oakland County lab's effort
and ability to detect fentanyl, fentanyl analogs, and the
emergency threat of the xylazine, and what challenges come up
in conducting this testing, and what Congress can do to provide
further support?
Sheriff Bouchard. Thank you. And I appreciate our
friendship too. In terms of our lab, you know, sometimes we are
not even aware of some of these changes that are being seen
from the street, and we hear about it from the medical
profession or elsewhere. So I have learned about xylazine
happening, I believe, in the State of Pennsylvania was where
some of it really started to catch fire. So I asked our lab to
figure out a way to test for it and then come back and tell me
what they were seeing. And I was shocked as they were how much
were in all of the test samples that were on their bench.
So the communication between public health and crime labs
is very helpful for us to know what we are looking for and what
we should be anticipating on the street and what our folks that
are touching and coming into contact that would need to be
aware of. You know, we had to change all of our field-testing
kinds of things because just coming into contact with certain
drugs has, as you know, caused overdoses for police agencies in
those situations. So I think that would be very helpful and
important.
Mrs. Dingell. Thank you. In your testimony, you mentioned
Oakland County's Crisis Response Unit and the Cosponsor
Program, which both partner healthcare providers and law
enforcement to implement preventative measures, find treatment
sources, and deescalate crisis situations.
Can you tell us more about the success of your partnership
with the Oakland Community Health Network, the importance of a
comprehensive approach that includes both law enforcement and
healthcare providers? And are you being impacted by current
potential Federal grant nonpayments.
Sheriff Bouchard. Thank you. At this point, none of our
staff have said they are having any interruption. But the
partnership is critical. We work hand in glove with our health
department with the community of coalitions, a group that
focuses on substance use disorder, and all of the associated
preventative, both educationally, free Narcan kits, visits to
school. I go to schools with this one group called Fentanyl
Fathers that tragically are in that club they never want to
join. One father talked about his daughter taking what she
thought was a half an Adderall pill, and it had fentanyl, and
it killed her. And so that is why we adopted The One Pill Can
Kill. And in some of our discussions--and the pill press thing
is very front and center with us as well.
I think it is important that, you know, we do those
preventative things in partnerships with all of those agencies.
We are not going to arrest our way out of it, but we can punish
the folks that are profiting from the suffering and the death
of others.
Mrs. Dingell. Thank you. We know more than when my sister
died. But, Dr. Camenga, your work focuses specifically on
addressing substance use and substance use disorders. Your
research has explored development of novel technology, enhanced
interventions to reduce drug use in adolescents and young
adults.
Can you share more about the status of these interventions
and their funding sources?
Dr. Camenga. As part of my research, I develop
interventions for vaping prevention in middle school students.
Students love technology. It is a way to communicate important
education to them. We have been developing these interventions
for years. Right now, we are on hold not knowing, you know, how
to continue to build them out until we understand funding a
little better.
Mrs. Dingell. Thank you, we need funding. I yield back, Mr.
Chair.
Mr. Carter of Georgia. The gentlelady yields back. The
Chair now recognizes the gentleman from Florida, Dr. Dunn, for
5 minutes of questioning.
Mr. Dunn. Thank you very much, Mr. Chair. Thank you, again,
to our witnesses for being here with us today. I am gravely
concerned with the illicit drugs that have been pouring across
our southern border for years. It is clear that this problem
requires significant attention to resources from us.
For years, the drug cartels have exploited our southern
border, and they are working with the Chinese Communist Party
to poison Americans. But alarmingly, recent reports show that
these cartels are mobilizing along our northern border as well.
They are creating super labs to illegally distribute drugs
throughout our communities.
I would like to submit an article for the record that
highlights these crimes titled, ``British Columbia organized
crime expanding export of fentanyl and other drugs,'' published
in the Vancouver Sun. And, yes, it was submitted earlier. So
thank you, Mr. Chairman.
Sheriff Bouchard, can you speak to how the drug cartels
actually move drugs across our border, specifically, how drugs
get from their facilities into the hands of our citizens?
Sheriff Bouchard. Thank you. They move it in a variety of
ways. They are much like any private company that is looking
for efficient, effective routes. Sometimes it is muled across
the border and then has transportation routes up into every
community. And other times, we see it shipped in or come across
in different fashions. We have seen it both in parcels and in
vehicles moved across the border.
Mr. Dunn. So in followup to that question, have you seen
the cartels adjusting their operations in response to how we
adjust at the border?
Sheriff Bouchard. One hundred percent, yes. They are very
nimble. They look for everything that we do. They look for
countermeasures. One of the largest seizures in the history of
our State happened in a dump house where they were storing
drugs about a mile from one of our substations. And we took
over policing that community. And within a month, we found
that, and it was staggering the amount of drugs. And it was
definitely directly tied to cartel activity.
Mr. Dunn. I appreciate your insights as critical. We do
everything we can, and we need to know those things that you
know to respond intelligently.
Dr. Westlake, as a medical doctor, I am interested to hear
from you as to how this issue presents in the emergency room.
You speak from your own experience, how the presentations of
drug overdoses have evolved over the last few years.
Dr. Westlake. I am sorry. I didn't understand the question.
Mr. Dunn. How have the presentations in the emergency room,
how are they changing over the last few years?
Dr. Westlake. Yes, so I think when we kind of saw the
start, and it was with prescription opioid epidemic, and there
were overdoses on prescription pills because of the
overprescribing issue, that has pretty much--at least in
Wisconsin, and my understanding across the country--it has
pretty much stopped, and now it has moved on to the illicit
substances. And then once they became the counterfeit
substances, you know, initially, it was people that knew they
were using and was taking risks, and now it has moved to people
that don't even know that they are using.
And the majority of overdoses that I see are people that
are not aware that they are taking fentanyl. The last 10
overdoses that I have seen in the last couple of months all
thought they were taking heroin. And when we tested it, there
was no opioid, it was all pure fentanyl that they were
overdosing from. So it has been a huge shift.
Again, it is fire hydrants taking it more soft into
different things.
Mr. Dunn. So I think that it is an important key point
there. People think they are taking something else. They even
think they are smoking some marijuana or something. And what
they get exposed to is a really, really dangerous substance.
And even microscopic amounts of it can kill.
So that is a--thank you very much. This threat is obviously
to all of us. We can't sit back and watch the cartels poison
our society. So I look forward to working with all of you and
all of my colleagues here to address these problems. Thank you
very much, Mr. Chair. I yield back.
Mr. Carter of Georgia. The gentleman yields. Is there a
question on the article to be inserted into the record?
Ms. DeGette. Mr. Chairman, what is source of this article?
Mr. Dunn. The Vancouver Sun.
Ms. DeGette. Thank you. I have no objection.
Mr. Dunn. The Vancouver Sun. It is a regular newspaper.
Mr. Carter of Georgia. Without objection, the article is
included in the record.
[The information appears at the conclusion of the hearing.]
Mr. Carter of Georgia. The Chair now recognizes the
gentlelady from Washington, Dr. Schrier, for 5 minutes of
questioning.
Ms. Schrier. Thank you, Chair Carter. And thank you,
Ranking Member DeGette. And thank you to our witnesses today.
In my State of Washington, like every other State, fentanyl
and other illicit drugs have had a profound and devastating
impact.
Last Monday, Washington State had a $155.6 million
disbursement frozen due to President Trump's halt of fentanyl
spending--excuse me, of Federal spending. And to be clear, that
amount of money included grants for SAMHSA, which is the
Federal agency responsible for substance abuse prevention and
treatment. And I just have to point out the real ramification
of Trump's Federal spending freeze--not opposed by a single
Republican so far--has on overdose deaths in this country.
I know everyone here is committed to stemming the flow of
illicit fentanyl and other drugs, that supporting a funding
freeze that guts substance use prevention and addiction
treatment programs is antithetical to solving this problem and
is absolutely reckless.
Mr. Cullen and others sitting in this room are family
members of people who have died from fentanyl poisoning. And
freezing treatment programs will only add more grieving
families.
I want to pivot to xylazine. It was later in coming to the
State of Washington. I am hearing our State narcotics
investigators that this use of xylazine as a cutting agent in
fentanyl is very much increasing locally. There is currently no
known treatment for xylazine overdose. And so Narcan, of
course, if you have a mixed overdose, may not save a life in
that case.
Ms. LaBelle, in light of the recent OMB funding freeze, I
wondered if you could speak to the impact of withholding NIH
funds, especially when it comes to developing xylazine
detection tests and potential xylazine reversal agents.
Ms. LaBelle. Yes, I mean, there--I can't speak to specific
grants that we have approved at NIDA, or will approve at some
point, but I know that having worked closely with people in the
University of Washington, there is a lot of ongoing research
that has to be funded. And the only people who have that type
of funding is the Federal Government through the National
Institute on Drug Abuse.
Ms. Schrier. That is right. Thank you very much. To pivot
to China's role in all of this, the People's Republic of China
shipped the precursor chemical needed to make fentanyl to
Mexico, the United States, or elsewhere in the world where that
has been assembled into fentanyl and fentanyl analogs by
criminal groups. And then it floods into the U.S. market.
I grilled representatives from the Chinese embassy about
this, and they so proudly claimed that they were addressing
this problem seriously. But then I pressed them on this, and it
turns out that, while they are supposedly curtailing the
shipments to Mexico, they are sending fentanyl precursors to
very suspect places around the world.
For example, they showed me a list. They are sending to
clinics and to hospitals. And as a physician, I can assure you
that there are no clinics or hospitals in this country
manufacturing fentanyl. It is still making its way to the
cartels.
So, Sheriff Bouchard, I was wondering what steps you think
the Federal Government should take to stem this flow of
fentanyl precursors from China.
Sheriff Bouchard. Oh, obviously, that is solely within the
purview of the Federal Government, is pressure on nation
states, especially ones that are dealing this into our country,
obviously, intentionally. And I think that great pressure has
to be brought to bear because they are the origin of a lot of
what we are seeing across the country in terms of death and
misery.
Ms. Schrier. Any specific recommendation that you would
make?
Sheriff Bouchard. That would get into policy things on how
the Federal Government deals with a nation state. You know, I
again go back to anything that would strongly enough discourage
them or let them know there would be consequences for them to
continue to traffic this into our country. I mean, you can get
xylazine mailed to you direct right now from China.
Ms. Schrier. It certainly is to their advantage to weaken
the United States, and this is part of what will do that.
Absolutely.
I just want to mention in these last 30 seconds, I am a
pediatrician, and so I am very concerned about the poisoning of
kids. They think they are buying something else, and 60 percent
is tainted with fentanyl, and so many of these are deadly
amounts. We have so many youths who overdose. They are now
filling our emergency rooms. There aren't enough treatment
facilities for them.
And so just a last quick question. I don't have time to ask
the question, but I will just point out that Dr. Camenga and I
both know that we need more resources for kids and treatment. I
yield back.
Mr. Carter of Georgia. The gentlelady yields. The Chair now
recognizes the gentleman from Florida, Mr. Bilirakis, for 5
minutes of questioning.
Mr. Bilirakis. Thank you, Mr. Chairman, for holding our
first healthcare subcommittee hearing on this very critical
topic, the illicit drug threats that are plaguing our
constituents through fentanyl-related substances that have
flooded through our borders, unfortunately.
I am thankful that President Trump has taken quick action
to address the border crisis. I am proud to join with
Representative Griffith and Latta in support of the HALT
fentanyl Act, which would finally classify fentanyl-related
substances as a class I drug and give law enforcement the
certainty it needs to fight back against drug traffickers. It
is long overdue.
And while we are trying to keep pace with this evolving
landscape, new threats continue to emerge, unfortunately. I am
proud to colead the Combating Illicit Xylazine Act with my good
friend, August Pfluger, and Jimmy Panetta, which would schedule
xylazine as a schedule III drug under the Controlled Substances
Act.
While the animal or--drug xylazine has horrific side
effects in human use, it prolongs the effects of fentanyl,
making it extremely dangerous on the streets. Our bipartisan
legislation strikes a key balance to provide more tools while
maintaining legitimate use for veterinarians and others to use
this drug safely without diversion in large animals.
So my first question is for Sheriff Bouchard. You touched
upon the emerging threat of xylazine and other new drugs in
your testimony.
Can you elaborate why it is critical from a law enforcement
perspective to keep, as you say, and I quote, ``a more agile
regulatory framework'' so we can address these threats faster
and more effectively?
Sheriff Bouchard. Thank you. Well, I guess it also touches
on what we just talked about. When you have a nation state
involved that has the resources and the capability to create
laboratories and factories that can quickly change one
component of what they are making in a lab and then suddenly
make it legal or have a different kind of thing that they can
send in, suddenly we are dealing with something we are not
aware of because they changed in the lab, and it is landing in
our laps. And that is how I found out about xylazine hitting a
different State and asked our lab, and it was already there.
And that is the kind of nimbleness we need to be capable of
dealing with when you have somebody that is intentionally of a
nation state status allowing that to occur.
Mr. Bilirakis. Thank you very much. Over the years during
this overdose crisis, we have sadly seen time and time again
parents were prescribed opioids for legitimate purposes--I said
parents, I meant patients. But still parents and kids, what
have you--like a surgery or an injury, but often go down on
paths towards illicit or diverted pills, and even fentanyl once
they are addicted. And this is the majority of the cases, in my
opinion.
Our committee has worked on policies that incentivized
nonopioids. And I have long been interested in encouraging
alternative therapies to pain management. I am glad to see that
last week, the FDA approved the first in-class nonopioid
alternative for acute pain.
So, Dr. Westlake, you testified about your inspiration
after the tragedy of your friend's son who was a victim of this
trend of getting hooked on legitimate prescriptions, which led
to worse illicit options, such as heroin. I believe this
contributes to further illegal fentanyl crossing our southern
border. And we should work towards methods to cut off the
demand here wherever plausible.
Would you agree that patient access to additional pain
management tools beyond opioids are an important component of
addressing the illicit drug threats in a comprehensive way? And
we have made some changes in the VA, but we have got to do
more. So if you can answer that question, I would appreciate
it.
Dr. Westlake. Yes, absolutely. I think opioids should not
be the last medication you use. I used to normally tell my
patients to, you know, use Tylenol and ibuprofen and
prescription strength, which has been shown as effective as
oxycodone for acute fracture pain. And then at nighttime only
to take opioids if needed if they are going to be pain from the
surgery or from the fracture--got to kind of get through that,
but they don't want to get hooked on opioids. Half of the
people that got hooked on opioids didn't start by trying to get
it.
Mr. Bilirakis. Thank you, sir. Mr. Cullen, thank you for
being here to tell about your story. I am so sorry to hear
about Zachary. I want to highlight an important part of your
testimony when you say most kids are not addicts. I believe
that they are stressed and anxious and that social media
provides a platform for kids to easily purchase drugs online,
which get laced with fentanyl and lead to overdose poisoning.
I am committed to holding Big Tech social media accountable
for enabling this on their platform. Can you share your
perspective on this and what suggestions you might have to curb
this horrific trend? Because we are going to refile COSA, and I
want as much input as possible, please.
Mr. Cullen. Yes, thank you for your question. Yes, we
talked to several of Zach's friends afterwards, and they told
us how easy that it could be, that you could order
prescription-strength pills off Snapchat, TikTok, Instagram,
that sort of thing, delivered right to your house.
I think what I spoke about in my testimony was that we
would like to see PSAs. But the PSAs need to be directed at the
platforms that they are utilizing, not ABC News, NBC News. That
is not where they are getting their information from. I think
it needs to be targeted. And I have seen some Ad Counsel ads
for drunk driving in the past week or so. I think that it needs
to be--something that needs to be elevated.
Mr. Bilirakis. Good suggestion. Thank you very much. I
yield back, Mr. Chairman.
Mr. Carter of Georgia. The gentleman yields. The Chair now
recognizes the gentlelady from Massachusetts, Representative
Trahan, for 5 minutes of questioning.
Mrs. Trahan. Thank you, Mr. Chair. Thank you, Ranking
Member. Thank you especially to our witnesses. I appreciate the
subcommittee's focus on an issue that affects Americans across
geography, demographics, and politics.
However, I would like to understand how broad funding cuts
backed by my Republican colleagues would undermine the efforts
to combat this addiction overdose crisis.
Overdose trends show a rise in fentanyl mixed with
xylazine, a powerful animal sedative known as tranq dope. First
responders in my home State of Massachusetts have seen it
spreading across communities. And what is particularly
concerning is that experts warn that Narcan is ineffective
against xylazine. And the FDA had stated it is unclear if
today's Narcan can reverse its effects. We can't be caught
flat-footed when the next dangerous substance like xylazine
emerges.
Additionally, the recent drop in overdose deaths is largely
due to increased Narcan access, which has been critical for
those with opioid use disorder.
So, Ms. LaBelle, how does significant NIH research funding
cuts undermine our ability to develop more effective overdose
reversal medication and keep pace with evolving overdose
crisis?
Ms. LaBelle. NIDA is the number 1 source of funding for
research worldwide. There is no philanthropy that can make up
for that. So it could have a devastating impact.
Mrs. Trahan. Thank you, Mr. LaBelle. It seems that we all
agree that strong support for the research landscape is key to
finding new treatments and lifesaving anecdotes.
The opioid crisis continues to devastate communities across
the country, and Medicaid has been a vital lifeline for those
struggling with substance use disorder, providing access to
essential treatment and recovery services.
However, my Republican colleagues support Medicaid
proposals that would cut Federal funding, especially in
Medicaid expansion. Many individuals with SUD could lose access
to critical care at a time when they need it most.
Ms. LaBelle, again, how would cutting Federal funding for
Medicaid expansion affect individuals with substance use
disorder who are already in a vulnerable situation without the
critical care that they rely on?
Ms. LaBelle. One good example is treatment, in carceral
settings, when people are leaving incarceration and need to be
connected to care. And about 15 States have been approved for
using Federal funds, Federal Medicaid funds. So cutting back on
that would devastate a population that is at heightened risk of
overdose.
Mrs. Trahan. Thank you. Sheriff Peter Koutoujian, the
Sheriff of Middlesex County in my State of Massachusetts, has
been a leader in tackling the opioid crisis through initiatives
like the Sheriff's Outreach and Recovery Program, which helps
individuals access treatment and support.
Sheriff Bouchard, could you just share an example of how
you collaborate with the Drug-free Community Grant Program?
Additionally, how would the potential loss of nearly 670,000 in
Federal funding as outlined in the OMB memo on behalf of the
President impact your work and the communities that you serve?
Sheriff Bouchard. Thank you. I can speak to the partnership
of the actual grants and who gets them, whether it is our
agency or our partners. It probably is more my CFO. But as it
relates to the partnership, it is critically important that we
are hand in glove. And a lot of those programs that we have,
our crisis response unit is in partnership with those folks and
with the grants. And having that capability to work together to
intervene, then connect them with the resources--as I said, in
one of those house visits after we had saved the individual
once, they were checking up on them and found them overdosing
again. Saved their lives. So to connect those resources in a
partnership is critically important so that we can not only
save lives but put them on a different path.
Mrs. Trahan. Thank you. Thanks so much again. I yield back.
Mr. Dunn [presiding]. The gentlelady yields back. I now
recognize the gentleman from Texas, Representative Crenshaw.
Mr. Crenshaw. Thank you, Chairman. Thank you for holding
this important hearing today. And thank you to our panel of
witnesses for being here.
I know we focused on this issue as a committee before. I am
sure it won't be the last time, and I am glad we talked about
it again. This is an easily bipartisan issue.
I wish some of my colleagues weren't wasting time talking
about a so-called funding freeze that is not even in effect.
That is a fact: It is not. The distraction from the fact that
fentanyl is pouring across our southern border, it is
trafficked by Mexican drug cartels, and it is laced into street
drugs that is killing our kids.
This isn't just a drug problem, this is a deliberate act of
poisoning against the American people, and cartels are the
culprit. As chairman of the Cartel Task Force, I have
introduced real bipartisan solutions to battle the cartels. We
have a lot of work to do to dismantle this terrorist insurgency
that is destroying both Mexican and American societies.
This is a supply problem. Whether someone is addicted or
whether they were just partying and got a pill that was laced
with fentanyl, the fact is they would have never gotten
fentanyl without the supply from cartels. Supply creates the
demand. It creates the addiction. That is a fact.
Another fact that deterrence matters. Criminals and cartels
will be less inclined to traffic fentanyl and deal it to kids
if the penalty is high enough. This is also a very simple
concept.
So I would like to start with Sheriff Bouchard. Thank you
for being here. In your line of work, how often do you come
across counterfeit pills?
Sheriff Bouchard. Regularly, sir.
Mr. Crenshaw. And let's talk about how these pills are
getting made.
How often are the cartels getting their hands on pill
presses, and who sells them?
Sheriff Bouchard. It is a big problem. Our narcotics team
and teams across the country and our Association of Major
County Sheriffs of America are seeing more and more pills that
look like something they are not that have fentanyl as a
component or are all fentanyl.
Mr. Crenshaw. Do you have any idea of where they are
getting them, who makes them? Is it just that, or is it just
extremely easy to get them so we don't know?
Sheriff Bouchard. It is extremely easy to get them right
now. They are not serialized, or there is not any kind of
registration requirement. So it is, in essence, you know, super
easy, and it is a pathway to bring something in under the guise
of something else. It is a Trojan horse that is killing a lot
of kids.
Mr. Crenshaw. So it would be helpful to serialize them and
be able to track these pill presses.
Sheriff Bouchard. Yes, sir.
Mr. Crenshaw. I appreciate that. And that is one of the
reasons I have bipartisan legislation that requires the
serialization of pill presses. Because we need to cut off the
cartel's access to the tools they use to manufacture this
poison and trick kids into taking something that they think is
something else, but it is not in the place of fentanyl.
Senator Cornyn also has this legislation in the Senate. I
would encourage everyone to get on this. Again, it is
bipartisan.
Sheriff, do dealers generally understand the danger of the
counterfeit pills they are pushing?
Sheriff Bouchard. The dealers do, but the kids don't. That
is why it is so deadly.
Mr. Crenshaw. But the dealers do.
Sheriff Bouchard. Absolutely. Understanding that fentanyl,
in even small doses, can kill people. And there has been kind
of a paradigm change over time where the old dealers of all
that have been in this business a long time, used to start you
with a little bit to get you to be a regular customer. Today,
they don't care how many people they kill.
Mr. Crenshaw. I agree with you. I think the dealers
absolutely know what they are doing. You know, in Texas, I
think we got it right, although I think we could even make this
law better. We passed the law to enhance penalties for fentanyl
distribution, giving law enforcement the ability to go after
these criminals with murder charges.
Since that law went into effect, overdoses in Texas are
down 56 percent. That was pretty good progress. The U.S.
Sentencing Commission data for fiscal year 2021 released last
year shows that the average for fentanyl trafficking was just
over 4 years--4 years, that is less than some people get for
robbery. Does that seem right?
Sheriff Bouchard. No, sir, because, you know, they are
spreading that pain well across your population before they
actually got successfully prosecuted for the one they did.
Mr. Crenshaw. I mean, you would agree that perhaps--would
there be an argument for a similar law at the Federal level to
put it on the dealers, that dealing fentanyl knowingly could
occur to a murder charge?
Sheriff Bouchard. I think that would send a very strong
message.
Mr. Crenshaw. It certainly would. Again, incentives matter.
I am nearly out of time on--in your experience as well, would
you say that cartels are exploiting the fact that fentanyl
analogs are not criminally classified as schedule I substances?
Sheriff Bouchard. Yes.
Mr. Crenshaw. Have you seen a decline in fentanyl overdoses
since Congress extended the temporary scheduling order?
Sheriff Bouchard. We have seen a decline in deaths, but not
necessarily overdoses because they keep changing.
Mr. Crenshaw. Well, I hope that as we vote on that today,
that we do make it permanent. Thank you, and I yield back.
Mr. Dunn. The gentleman yields back. And I recognize
Representative Veasey from Texas.
Mr. Veasey. Absolutely. Thank you very much. I want to
thank--I know that Chairman Carter had stepped away, but I want
to thank him and everyone on this panel, the way that they have
been addressing the grieving parents that are here and other
people that have experienced loss due to fentanyl.
In the '80s and '90s, people just used to talk about people
that have become addicted to drugs or were using drugs, just
talked about them like they were dirt and garbage.
And I am just happy that there seems to be a bipartisan
sense in this committee that we need to get beyond that and
actually try to help people do better, whether or not we
disagree on their approaches. I think the language that has
been used here today is really encouraging.
And I want to thank Mr. Cullen for sharing a story about
his son. I have an 18-year-old son that is a freshman at
college. And I was talking to my wife the other day, and I
said, you know, even if your kids aren't on drugs, they are
saying that you should keep a can of Narcan at your house just
in case one of your friend's kids come over. And it might not
even be something that is drug-related.
A lot of the pressures that high school and college
students are under today to keep up will oftentimes send them
onto the black market for Adderall and ADHD-related drugs. And
sometimes they are fake pills that are laced with Adderall. So
it may not be anything that is cocaine or heroin or I-want-to-
get-high related. It may just be someone just trying to keep up
in what is a very competitive universe in our college campuses,
and they are absolutely victims.
But I want to be clear, when we discuss solutions here
today. President Trump just illegally seized $8.6 billion in
Congress-approved opioid funding. And the fallout has been an
unmitigated disaster, I think, due to the chaos that was
unleashed by the Government freeze.
And I want to just, you know, say something that my
colleagues said that there ended up not being a Government
freeze. But before the 5 p.m. deadline, there were federally
qualified healthcare centers across Texas that couldn't get
into the database. So they couldn't treat people for things
like what we are talking about here today.
And there is a federally qualified healthcare center in
Virginia just this past Tuesday that announced the closure of
several locations because they still cannot access their
funding to help the people that you are here talking about
today and that other people are here talking about today. And
so this isn't some sort of a game. This is serious, and lives
are at stake.
And so I wanted to ask the sheriff, Trump's illegal funding
freeze put critical programs like high-intensity drug
trafficking area programs at risk, programs that help law
enforcement, including your own, in the fight against fentanyl
in high-risk areas. And even the Office of National Drug
Policies web page has been wiped by President Elon.
And so, Sheriff, can you confirm, yes or no, that the
programs like HIDTA and other Federal grants are essential for
reducing the supply of fentanyl in your community?
Sheriff Bouchard. Yes, HIDTA is very important, not only
for your coordination but deconfliction and partnership.
Mr. Veasey. So you agree that a funding freeze or any
attempt to freeze these funds or cut resources directly
endangers Americans by weakening our efforts in the fight
against fentanyl?
Sheriff Bouchard. Well, as I said earlier, my staff hasn't
told us there has been any shutdown in terms of our operations
that we are aware of, but obviously, it is an important
program.
Mr. Veasey. Yes, well, thank you very much.
This is for the professor. Last year, there was a
bipartisan Senate bill that would have delivered critical
resources to the border to combat fentanyl trafficking and
funding that law enforcement and public health officials agreed
was desperately needed to stem the flow of drugs into our
country.
But instead of putting public safety first, the President
and the Speaker of the House decided that for political gain,
that we would slow the immigration bill. And now a year later
we are still waiting for any meaningful action from colleagues
to help stop the pour of fentanyl into our legal ports of
entry.
And given this failure, what sort of resources are most
urgently needed to strengthen interdiction efforts and disrupt
the supply of fentanyl and other dangerous substances at our
ports of entry?
Ms. LaBelle. So I think there are three pieces. First is
investing in our workforce so they are trained. The second is
intelligence sharing. And lastly, the technology, so we have
the best technology to identify drugs that may be coming in
over the border.
Mr. Veasey. Thank you very much. Thank you, Mr. Chairman, I
yield back.
Mr. Dunn. The gentleman yields back. I now recognize Dr.
John Joyce from Pennsylvania for 5 minutes.
Mr. Joyce. Thank you, Chairman. And thank you for holding
this hearing. And thank you to all the panel for taking out of
your busy schedules to be with us. I also want to acknowledge
and thank Chairman Griffith for his incredible work on the HALT
fentanyl Act, a bill that I am proud to be a cosponsor. And
look forward to see its passage through the House of
Representatives this week.
Since the inauguration of President Trump, we have seen
President Trump take immediate action to combat the growing
threat of illicit fentanyl flowing through our borders. He
designated the cartels in Mexico as a foreign terrorist
organization and reached an agreement with the Mexican
President to deploy her country's National Guard to help stop
the transport of this deadly drug into our country.
Unfortunately, these positive steps come only a few years
after the inaction of the Biden administration. And because of
that delay, fentanyl poisoning has risen dramatically, with 7
out of 10 illicit fentanyl pills tested by the DEA in 2023
containing a potentially lethal dose of fentanyl. That is 7 out
of 10. And go back just 2 years before that, it was only 4 out
of 10. Why would I say ``only'' 4 out of 10 deadly pills?
Ray Cullen, thank you for being here. Thank you for sharing
the story of your son, Zach. Can you talk about how fentanyl
poisoning is distinct from an accidental overdose?
Mr. Cullen. Yes, thank you for the question. So, in my
opinion, an accidental overdose is when someone takes
something, whether prescribed or not, more of what they were
supposed to than the body could handle. A poisoning to me means
that someone took something that had something in it that they
were not expecting.
So in our case, Zach purchased cocaine. Bad decision. But
the coroner told me that there was more fentanyl than cocaine
in his system. So he did not die because he took too much
cocaine.
Mr. Joyce. So the accidental deaths that we are seeing
because of this poison being mixed in to other street drugs is
causing the increase of the fentanyl deaths that we are seeing
in the United States. And many of these are fentanyl analogs--
fentanyl analogs laced into, as you mentioned, cocaine that are
being created by the Mexican cartels. And they use precursor
drugs that are created by the Chinese Communist Party. And
those are shipped to Mexico, where the cartels, in their labs,
mix these drugs up, or use these pill presses, or mix them up
with other drugs, as simple as marijuana as well.
These are multinational organizations. They are sending
thousands of pounds of deadly drugs into the United States to
kill our friends, our neighbors, our children.
Mr. Cullen, with all of this in mind, do you agree with
President Trump's classification of the cartels as foreign
terrorist organizations?
Mr. Cullen. One hundred percent. This was something that we
brought up at the roundtable about 2 years ago, where that was
one of the things that we would like to have seen happen, along
with the declaring fentanyl a weapon of mass destruction.
Mr. Joyce. Dr. Westlake, as an emergency physician, can you
speak to how continued emergence of new, deadlier illicit drugs
make it more difficult for you, when you are in the emergency
room, which you were just this week, and patients that come in,
do you have to use higher doses to reverse the overdoses that
you are seeing?
Dr. Westlake. Yes. Thanks for the question, Congressman. It
kind of depends. So Narcan works, and it works well. But the
problem isn't that there isn't a potent enough Narcan, although
that may be partially the problem. The problem is that people
are exposed to these poisons to begin with. The prevention of
stopping them from existing is critical.
I also want to point out one thing going back to weapons of
mass destruction. Fentanyl is more deadly than Sarin nerve gas.
It is easier to die from Sarin nerve gas than from fentanyl.
The lethal dose is higher in Sarin. So it is a chemical-
weapons-based created poison.
Mr. Joyce. As we sit here and discuss the threat the
cartels are working, this multinational and described as being
a nimble group by the sheriff here, they are working to create
cheaper and deadlier drugs to smuggle across our borders.
We have responsibility here in this committee and in
Congress to protect our communities from these ongoing and
emerging chemical threats. While the passage of the HALT
Fentanyl Act will represent a great start, I remain personally
committed to combating the production and sale of all of these
illicit substances.
Thank you, Mr. Chairman, and I yield back.
Mr. Dunn. The gentleman yields back. I now recognize the
gentlelady from New York, Ms. Ocasio-Cortez.
Ms. Ocasio-Cortez. Thank you, Mr. Chairman.
Thank you all, to all of our witnesses here today, sharing
their expertise and their story.
And, Mr. Cullen, thank you for sharing your son's story
with us here in the committee. And I think it is tremendously
important that we communicate to you that what happened to your
son will not happen in vain and that we are going to fight to
make sure that there is real change that happens to ensure that
victims across the country are protected from this happening
ever again.
I represent the South Bronx, and the South Bronx,
historically, if it were its own State, would have the second-
highest per capita rate of overdoses in the entire country,
second only to West Virginia. And so this is a well-known issue
in our community.
I, like the ranking member, keep Narcan in my car. We have
communities that have been ravaged by fentanyl. And one thing
that is also in New York's 14th Congressional District is
Rikers jail.
We have seen the impacts of schedule I on certain drugs and
substances, and these scheduling differences matter, schedule
II, schedule I, schedule III, et cetera. When we look at the
impacts of these things, what I think is very important when we
look at schedule I is the presence of mandatory minimums. And
what happens in mandatory minimums is that many of the victims
of fentanyl distribution, drug distribution, themselves become
incarcerated, while many of the upstream distributors go off
scot-free.
If we want to address this issue, we need to look at
financial crimes. And, in fact, many of the industries
responsible for supercharging the distribution of fentanyl are
getting off without enforcement, and one such industry is
crypto. And I think it is very important that if we want to
make sure that we take an important approach on this, we need
to go after the folks who are responsible for the upstream
distribution of this.
But I want to put that aside. Ms. LaBelle, in your
testimony, you named some very key different factors in this
crisis and how we can address it. First, you named
transnational efforts, which I think are tremendously important
and, to that extent, addressing the financial chokepoints that
actually reward fentanyl trafficking.
But then, secondly, you talked about prevention and
treatment. And one thing that I thought was very significant in
your testimony is you naming the healthcare agencies that are
responsible for helping reduce fentanyl and fentanyl use, and
one of those that you named was not just the CDC, the NIH, but
you also named Medicaid.
Would it be fair to say that Medicaid is actually one of
the most important and strongest protections we have in the
opioid crisis in the United States?
Ms. LaBelle. Yes. It treats a lot of people with addiction
who would not otherwise be able to receive care.
Ms. Ocasio-Cortez. And cutting off Medicaid and cutting off
access to Medicaid could potentially increase the fentanyl
crisis in the United States and certainly result in deaths from
the fentanyl crisis?
Ms. LaBelle. I have--I think it is safe to say that, if
Medicaid were significantly reduced, more people would die of
overdoses.
Ms. Ocasio-Cortez. So we are talking about the prospect of
cutting Medicaid as exploding the fentanyl crisis in the United
States. And I imagine you see in many communities where there
are fentanyl--when there is widespread fentanyl use, there's
also large interplays with the Medicaid system, correct?
Ms. LaBelle. Yes.
Ms. Ocasio-Cortez. Can you explain that a little bit
further, what you see?
Ms. LaBelle. So, I mean, people are, especially in Medicaid
expansion States--I mean, one area that I keep bringing up, but
it is so important, and we have done a lot of work on this at
Georgetown, is people upon leaving incarceration are at 10
times greater risk of overdose. And so cutting off Medicaid for
that population will leave them not only probably more
mortality but also increase their risk they are just going to
end up back in prison.
Ms. Ocasio-Cortez. So one of the things you are saying,
very importantly, someone leaving incarceration is at 10 times
higher risk of overdose. Demand. And so incarcerating people
too broadly can also create a demand on fentanyl because these
are people who are struggling with a lot of these issues.
And I think one of the things that is important for us to
see here is, in those threats to Medicaid, just last month in
our continuing resolution, we had bipartisan efforts to address
fentanyl, including expansion of Medicaid to address the
fentanyl crisis, treatment, that the Republican majority
stripped on orders of Elon Musk.
People are dying because of this, and we have to make sure
that we are protecting our Medicaid system, not cutting it,
because cuts to Medicaid are going to expand our fentanyl
crisis.
And with that, I yield back.
Mr. Carter of Georgia [presiding]. The gentlelady yields.
The Chair now recognizes the gentleman from Ohio,
Representative Balderson, for 5 minutes of questioning.
Mr. Balderson. Thank you, Mr. Chairman. Thank you all for
being here today.
My first question is for Dr. Westlake. And Dr. Joyce
touched on it a little bit. I know your experience is in the
emergency room, but I am interested in hearing how Wisconsin
has approached provider education for opioids. I know that your
experience is largely with the ER, but I would like to ask what
you believe can be done regarding postop monitoring to reduce
the number of Americans that come away from surgeries with an
opioid addiction.
Dr. Westlake. Yes, that is a great question, Congressman.
So I actually was a Medical Examining Board chairman and
led the Wisconsin prescription opioid reform effort and started
doing that in 2014, over 10 years ago. So I led, and my
strategy was implemented and was key for there to be prescriber
education. So we look for a cultural shift in prescribing. I
mean, honestly, the derivation of the opioid crisis began with
pain is the fifth vital sign. You know, mandated treatment of
pain, patients have a right to have their pain treated, kind of
forced our hand as physicians. And we released that, and then
we mandated prescriber education through the Medical Examining
Board. So we have got to be careful. Medical regulation and
education needs to go at the State level through the Medical
Examining Board.
You know, the Federal Government is great at providing
grants to the municipalities and localities that can then
implement the strategy that they need. So education is key but
also education of the entire populous that you don't need
opioids for pain, and I think that that has happened, and I
think we have seen a significant decrease.
But you are right: We need to make sure that we don't
overprescribe, continue to overprescribe, and use other
treatments, other methods.
Mr. Balderson. I can validate. I had a hip replacement and
I have had a surgery replacement, and they cut me way back,
so--thank you.
Sheriff, thank you for being here today and thank you for
your service. I represent a district in central and southeast
Ohio which is largely rural. The opioid epidemic has devastated
the State of Ohio and Ohio's 12th Congressional District for
years. Ohio has the second-highest opioid overdose rate, with a
whopping 39.2 deaths per 100,000 people. The State's opioid use
rate is twice the national average, encompassing 1.4 percent of
the State's population. And, unfortunately, opioid-related
deaths have continued to increase over the past 4 years.
Can you talk to me a little bit about what policies are
being employed in rural areas to reduce the opioid use and
misuse?
Sheriff Bouchard. Thank you. Yes. You know, we have, in my
county, both urban and rural, and so a big part of that,
obviously, is education to try to make sure that people are
aware of the dangers. Again, that is why we use the One Pill
Can Kill kind of thing to explain that. So many people are
unaware. When you tell most parents that, they get this blank
look on their face and they are horrified. And to have that
communication with their kids, so we try to go into schools,
and we have a lot of our SROs, our school resource officers,
talking to kids about that. We partner with the folks that,
unfortunately, like Mr. Cullen is a part of a club he never
wanted to join. We have some of those. I believe Rebecca from
our county testified she lost two of her sons in one day. When
you have parents that are willing to rip off the scab of
something that is so horrific to explain it to others, it makes
a deep impact on them.
So we do a lot of education, partnership with our
prevention, our coalitions, our health department. And then we
are vigorous in our enforcement to go after those that are
making profit off of, again, other people's misery and death.
My daughter played soccer with a lot of girls on her team,
and three of those girls have perished from overdoses. And it
is primarily the pathway that they got into it was through
sports injuries. So the paths alter and are varied, but the
outcome is typically the same.
Mr. Balderson. Thank you. I like the SRO, the resource
officers in the schools.
I have another question for you, Sheriff. In 2022, Ohio
ranked third in the country for the highest total fentanyl
deaths. While the number of Ohio deaths caused by fentanyl have
decreased since 2022, there are still far too many lives lost
at the hands of fentanyl.
What steps, whether it be through policy or enforcement, do
you believe must be taken to better combat the risk of
accidental fentanyl use, both from a law enforcement and a
public health perspective?
Sheriff Bouchard. Well, I think the step of permanently
scheduling is a good step, and it is important. I think a
continuation of the partnerships with health and law
enforcement and all across the different disciplines is
critically important. The communication between the labs of
trends and what they are seeing and how we get in front of it
and prepare for it and respond to it, you know, all of those
are critically important components. And I think a lot of the
facts that we are seeing a reduction in deaths isn't
necessarily because we have won, it is because we have more
people out there with Narcan or Opvee who are saving lives and
giving folks a second chance, and, you know, we have broad
distribution. We have vending machines all across the county. I
have a vending machine that is free when you leave the jail for
Narcan in it. They can take it with them.
Mr. Balderson. OK.
Sheriff Bouchard. And I think that is in part why we are
bringing it down. We definitely have not won the war on this.
Mr. Balderson. All right. Mr. Chairman, thank you very
much. I yield back.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognizes the gentleman from Massachusetts,
Representative Auchincloss, for 5 minutes of questions.
Mr. Auchincloss. Thank you, Chair.
There is no policy issue more personal than the opioid
crisis. I think to the exhibit I went to in my own district of
parents telling the stories of their children who had had their
developing brains hijacked by the most addictive chemical in
history, and hearing about these bright, promising kids who
descended into a spiral of lying and stealing and addiction and
broken relationships, and at the end so many of the parents
said that their focus was on just letting their kids know that
they were loved before they died.
And we all have an obligation to stop this epidemic, and I
appreciate and applaud each of the five of you for the work
that you are doing there, and in particular you, Mr. Cullen,
for your bravery in coming forward with your wife on this
issue. There's none of us up here on the dais whose decisions
as 23-year-olds would survive congressional scrutiny, and
coming forward with this story is so powerful because the word
you used, ``poisoned,'' is exactly the right word. He was
poisoned.
And it is not just the cartels, as the gentleman from Texas
pointed out rightfully. It is also the Chinese Communist Party
who are engaged in a state-sponsored poisoning of the American
public. Ninety-eight percent of fentanyl precursors are coming
from the Chinese mainland. These chemical manufacturers are
being facilitated and subsidized by the Chinese Communist
Party, oftentimes at a profit of individual CCP members.
And as cochair of the Fentanyl Working Group last term, I
introduced three pieces of bipartisan legislation to interdict
the supply of this fentanyl directly on the Chinese mainland
because, as all five of you have said, prevention, preventing
this chemical from reaching the U.S. mainland, is the best way
to stem this tide. And I would implore my Republican
colleagues, instead of taking a buzz saw to SAMHSA and to
Medicaid and to the program--and to biomedical research, the
programs that we know help treat people with substance use
disorder--work with us on the three pieces of bipartisan
legislation already introduced to create a joint task force to
counter opioids, to sanction the Chinese manufacturers of
fentanyl, to emplace fines on Chinese shippers whose manifests
do not recognize that they have fentanyl on these ships. These
are things that we can work on right now if the GOP would come
under the thumb from Elon Musk.
Dr. Westlake, I want to transition to the other side of the
problem, which is not on supply but on demand. A couple of
other colleagues have mentioned Journavx, which is the new drug
that has been introduced for acute pain that is nonopioid
based. And this is the fruits of two decades' worth of
biomedical research, biomedical research that my Republican
colleagues are trying to cut. And it is going to be, I think, a
game changer. Forty million Americans are diagnosed with acute
pain every year. Eighty-five thousand of those develop opioid
use disorder, and this drug is similar in its efficacy for
treating pain without being addictive.
Now, the problem is the commercial health plans are
creating the generic-level copays for this drug, but on part D,
where millions of Americans access their prescription drugs and
where a lot of people with acute pain will get their drugs, the
copay is at $50, more or less, whereas the opioid copay is at
about $2.
Based on your experience dealing with patients with acute
pain, do you think that difference in out-of-pocket cost might
disincent the use of the less addictive painkiller?
Dr. Westlake. Yes. I always--when I prescribe medications
for people, I always just start with something even more simple
than that, than anything prescription. Tylenol and ibuprofen
together, if you can take them, are as effective. But I think,
yeah, definitely cost is a driver of what patients take. If
they can get something for 2 bucks versus, you know, 50 bucks,
there is going to be a shift towards the less expensive.
Mr. Auchincloss. Ms. LaBelle, would you agree that a higher
copay is disincenting exactly the behavior we want to see?
Ms. LaBelle. Sure. I mean, you know, people are cost
sensitive, and that is a lot of money.
Mr. Auchincloss. That is a lot of money. And we know that
anything particularly above $35 copay tends to really rapidly
disincent patient adherence.
This is an example, again, of the pharmacy benefit
managers, the health insurance's own drug pricing middlemen not
enacting and enforcing their formularies in a way that is
actually helpful to public health. They are directly
undermining public health by pushing the opioids. And by the
way, there is huge evidence that the PBMs profited off of the
overprescription of these opioids. They are continuing to push
these opioids on to part D beneficiaries despite the fact that
there is a brand drug out there that is nonaddictive that
treats pain similarly and that they could easily put forward at
the same copay tier if they wanted to.
I will yield back.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognizes the youngest and the prettiest
pharmacist in Congress, Representative Harshbarger from
Tennessee.
Mrs. Harshbarger. You are so sweet. Thank you, Mr.
Chairman.
Thank you to the witnesses for being here today. I am the
other pharmacist in Congress.
And, Mr. Cullen, condolences to you and your family for the
loss of your son, and only someone who has lost a child can
understand what you have gone through, and I am sorry about
that. And I am glad you gave us a list of things to look at and
prioritize. It is going to help us quite a bit.
I want to start with a question to Dr. Westlake. You know,
in my view, we need to be as bold as possible when it comes to
taking steps to protect our children and our families from
these illicit fentanyl overdoses. And, you know, you talked
about the FRS--the opioids, the nitazenes, the xylazines--the
things that you are seeing in the ER. In east Tennessee I have
talked to my healthcare providers and my law enforcement, and
they are saying it is taking multiple doses of naloxone to
bring these people out, because you know as well as I do,
naloxone and fentanyl bind to different receptor sites. And I
know they are working on some--I think it is a cannabidiol
modifier to reverse that fentanyl.
So I guess the thing is, my question would be, what are you
seeing? How many doses is it taking to reverse these people
when you see them in the ER, or law enforcement?
Dr. Westlake. So what I see in Wisconsin is that, you know,
again, the issue is having the Narcan in law enforcement, the
first responders on the scene. You know, sometimes, people do
come in, and they have too much opioid in their system, and so
the Narcan wears off. But my experience is that the critical
access point is getting them the intervention of the initial
reversal agent.
Mrs. Harshbarger. That initial dose.
Dr. Westlake. So we are not seeing that, but that is not to
say that that is not an issue nationally. It is just we are not
seeing it in Wisconsin.
Mrs. Harshbarger. Well, Sheriff, even with some of the
drug-sniffing dogs, they have to carry the Narcan because the
dogs will get a--you know, they will be overdosed as well. Is
that what you are seeing in your area?
Sheriff Bouchard. Yes, ma'am. We actually have Narcan. We
have changed our procedures for handling and evidentiary rules
for our narcotics team and our road deputies because of the
risk that they can overdose from mere contact with some of
these components.
Mrs. Harshbarger. You are probably triple-gloving, aren't
you? Even the switch in evidence. You know, when I was on
Homeland Security, they would have to double- or triple-glove
just to transfer the evidence, because the skin is the biggest
organ that will, you know, take that fentanyl up.
I will go along with this one, Sheriff. You mentioned the
challenges of those pill presses, those tablet machines, that
we need better regulation around the possession of those. I am
a compounding pharmacist so, you know, a lot of those
compounders will use tablet presses to do, you know,
prescription drugs. But most of those come from China, if I am
not mistaken, when they ship those in. But it is the dyes that
make those drugs look like the Xanax or the Percocet or the
Adderall.
I guess, where are you finding out--are you looking to see
who is making those dyes for the tablet machines?
Sheriff Bouchard. If we find them in our AOR, we are. But
sometimes, you know, we get a bag of pills and we don't know
where they were pressed into being, if you will.
Mrs. Harshbarger. Yes.
Sheriff Bouchard. Obviously, you know, everybody can go
online and look up the numbers and say, ``Oh, this is a pill I
have.''
Mrs. Harshbarger. Yes.
Sheriff Bouchard. But that is not the pill they have.
Mrs. Harshbarger. Well, no. And they are using the fentanyl
as fillers just to--you know, it is easier to make fentanyl
than it is cocaine or heroin. You can make it in a few hours.
It is easily transportable, and that is why they are--you know,
and they sell it for 100 times more than what the cost of the
drug is. So there you go.
I want to continue along that line and ask about the HIDTA.
I saw some statistics, and in 2022, we had 134 criminal
organizations that were dismantled by HIDTA. We had over 8,700
kilograms of drugs that were removed nationally. And the
Appalachian HIDTA--because I am in east Tennessee--a task force
was operating, and Tennessee was responsible for removing drugs
off the market that had a street value of $51 million.
And I just want you to tell us a little bit more about why
it is important to continue that program, sir.
Sheriff Bouchard. It is important to continue the program
because there are so many layers to this that are outside our
own individual circle. So I have one of the largest counties,
but they are not just making it and distributing it in my
county. So where it is coming from can be anywhere in the
world, so that is why coordination and communication and
deconfliction are all critical components, and that is where
HIDTA comes in.
You know, I have got people assigned to the DEA. They have
people assigned to me, but we all have to do that systemically
to target a problem that is coming from other countries.
Mrs. Harshbarger. Yes. It is interagency collaboration.
And I guess with that, Mr. Chairman, my time is up, and I
will yield back.
Mr. Dunn [presiding]. The gentlelady yields back.
And I now recognize the gentleman from Louisiana, Mr.
Carter, for 5 minutes.
Mr. Carter of Louisiana. Thank you, Mr. Chairman. And thank
you to our witnesses.
Particularly, Mr. Cullen, my heart goes out to you for your
great loss. As a father of two sons, I could only imagine the
pain that you and your family suffers, and know that we care
and that we are desperately trying to find a way to address
this epidemic that we have with fentanyl-laced drugs that are
taking the lives of far too many of our people.
I am concerned about the President's proposed freeze, and I
know our colleagues suggested we shouldn't talk about the
freeze because the freeze has been blocked because it is, in
fact, unconstitutional. My fear is that there may be another
attempt or another approach used to slow, reduce, or cut
resources that would aid in the slowing and hopeful elimination
of these uses of fentanyl.
We know that SAMHSA, the Office of National Drug Policy,
Federal funding makes up 60 percent of the budget in New
Orleans, which goes a long way to addressing the concerns. It
is important to tell the real story about the lives of people
who are impacted by these cuts, people who depend on resources
that will aid them in getting off of illicit drugs or having
education so they never get on them in the first place.
Odyssey House in Louisiana currently operates several
SAMHSA-funded projects of regional and national significance,
including a rural-area drug court which diverts individuals
with drug-related offenses into treatment and case management
aimed at reducing recidivism. Freezing or eliminating these
grants could result in some $600,000 a year loss for the
organization, staff reduction, and loss of vital services. This
directly impacts the people who need the resources the most.
I would like to ask Ms. LaBelle--and thank you for your
testimony with us today. As a former official of ONDCP, I was
hoping that you could speak to the negative ramifications of
this proposed freeze or any other freeze that may take dollars
away from this vital action.
Ms. LaBelle. Thanks. Thank you, sir.
So, I mean, for too long we have had a bake sale approach
to addiction, and we have put scraps together to fund the
Nation's addiction treatment prevention program and supporting
recovery. Now, Congress has been very generous in the last
several years also through Medicaid expansion to make sure that
we no longer have to scrap for pennies to put together the type
of comprehensive approach. So cutting it further will set us
back.
Mr. Carter of Louisiana. And real quickly, I have got a
little bit of time, Dr. Camenga, I would like to thank you for
the incredible work that you have done, as with all of the
witnesses. Bless you for the great work that you do. This is
really a all-hands-on-deck, bipartisan effort to cure a
horrible ill, a horrible stain in our country. But if we were
to look at the disturbing actions in taking down critical
public health information on Government websites--agencies such
as CDC have taken down pages such as the Youth Risk Behavior
Surveillance System--how does the removal of this critical
information impact the work of providers such as yourself?
These are places where people can get information on how to get
help.
Dr. Camenga. Removal of that information really has real-
time impacts on healthcare providers as well as public health
professionals. We look to that to say how we should be focusing
our clinical care or how we should in communities be directing
resources, and not having that available makes it very
difficult for States in real time to know how to direct funding
for programs.
On the clinical front, the removal of clinical information,
as was described, can have direct clinical impacts in real
time. And the longer they are down--and I will speak from a
different perspective--is as a medical educator, our trainees
who will be taking care of us as physicians as we age are not
learning that, because those are the foundational documents
that we use to teach new healthcare providers how to provide
care. The longer we can't access it, think about it, they may
lose the opportunity to learn about standard evidence-based
practices.
So, yes, the removal of that information definitely has
real-time clinical impacts as well as impacts on public health.
Mr. Carter of Louisiana. And my time is up, but I will
close real quick by saying, if ever there was an issue that
called for a bipartisan effort to fix, the epidemic of fentanyl
in our country certainly is that.
Mr. Chairman, I yield.
Mr. Dunn. The gentleman yields back.
And I now recognize Dr. Miller-Meeks for 5 minutes for
questioning.
Mrs. Miller-Meeks. Thank you very much, Mr. Chairman. And
thank you to the witnesses for testifying before the
subcommittee today.
This hearing could not come at a more important time with
the House considering H.R. 27, the HALT Fentanyl--let me repeat
that: ``fentan-ill,'' not ``fentan-all''--the HALT Fentanyl
Act, which I proudly cosponsor.
Let me also say that it is critically important that it is
a bipartisan hearing, and it would have been very helpful to
have bipartisan support for securing our southern border and
reducing the flow of fentanyl, fentanyl precursors into this
country, especially through Mexico and, as you have heard,
incentivized by the Chinese Communist Party to send fentanyl
precursors to this country.
According to the CDC data, we lost more than 110,000
Americans to drug overdose deaths in 2022. It is estimated that
75 percent of these deaths involved opioids, meaning that 226
Americans died every day to opioids.
While many cases of drug-related deaths are poisoning,
where the individual does not know the product they are about
to use is laced with another substance like fentanyl, more
needs to be done to prevent addiction, including minimizing
unnecessary exposure to opioids. And as a director of public
health and as a State senator, I was very influential in
getting substance use disorder treatment as well as reducing
preauthorization to medicated-assisted treatment for substance
use disorder, as well as trying to stem the flow of opioids.
Ninety percent of acute-pain patients receive opioids to
manage their pain, whether they need them or not. Between 2011
and 2019, opioid prescriptions decreased by 40 percent, from
approximately 250 million to 150 million prescriptions
dispensed.This is true across most payer audiences: Medicaid,
private, and cash patients. However, among Medicare patients,
opioid prescribing actually increased. Medicare's share of
opioid prescribing during this time increased substantially,
from approximately 20 percent to the country's opioid
prescriptions in 2011 to 35 percent in 2019. This represents a
75 percent increase in just under a decade.
We clearly have more work to do in Medicare to make sure
that patients have access to effective pain relief agents while
also not unnecessarily exposing them to narcotic painkillers.
One way to do this would be to increase access to nonopioid
pain management medications, which I am proud to accomplish
with my legislation, the Alternatives to PAIN Act. This
legislation, which I thank Congresswoman Barragan for
cosponsoring and coleading, would decrease barriers to
accessing nonopioid pain management alternatives that are FDA-
approved.
Dr. Westlake, thank you for testifying today. Do you agree
that prevention needs to be part of our strategy to combat
illicit drug use and addiction?
Dr. Westlake. Absolutely.
Mrs. Miller-Meeks. Do you believe that our current
reimbursement policies appropriately align incentives to ensure
patients have access to opioids and nonopioid pain management
alternatives?
Dr. Westlake. Yes, I think it is important to make sure
that they are cost-effective solutions.
Mrs. Miller-Meeks. And do providers have the education and
resources available to know what other alternatives could be
available?
Dr. Westlake. I think so. I think so.
Mrs. Miller-Meeks. Do you agree or think that patients
should not be forced to fail first on an opioid before being
given the option to use a nonopioid to treat their pain if a
nonopioid is prescribed by their doctor?
Dr. Westlake. Yes, that seems counterproductive.
Mrs. Miller-Meeks. And how would you suggest Congress work
to appropriately align incentives to ensure seniors have access
to novel nonopioid pain management alternatives, especially in
the postacute hospital care setting or as they are discharged
from the emergency room?
Dr. Westlake. I think you, again, try to encourage
nonprescription, you know, solutions, not prescription drugs,
but also to make sure that there is some parity in the cost-
pricing structure.
Mrs. Miller-Meeks. Thank you.
Switching gears, I would like to focus on another
critically important issue that pertains to people purchasing
drugs over social media applications, especially our youth. The
U.S. Centers for Disease Control and Prevention recently
published an analysis finding a 182 percent increase in illicit
fentanyl poisoning or overdose deaths among 10-to-19-year-olds
between 2019 and 2021.
Again, our condolences, Mr. Cullen.
Counterfeit prescription pills were present in nearly 25
percent of deaths. The DEA released an updated public safety
alert finding that 6 out of 10 fentanyl-laced counterfeit
prescription pills contained a potentially lethal dose, which
was an increase from the agency lab's analysis from 2021, when
the rate was 4 out of 10.
Sheriff Bouchard, as a result of online sales, do you think
a framework like the one I outlined in platforms directing
social media, such as the Cooper Davis and Devin Norring Act,
would be helpful in reducing these tragic deaths?
Sheriff Bouchard. Yes. I think we have to look at the
component of what technology and social media companies are
doing and taking part now, especially as many of them have
moved or have already moved to end-to-end encryption. We know
that that is a big challenge on so many levels, and many of
them are resistant, if not outright obstructionists, to law
enforcement, even with a valid search warrant.
Mrs. Miller-Meeks. Thank you so much.
I see my time has expired. I yield back.
Mr. Carter of Georgia [presiding]. The gentlelady yields.
The Chair now recognizes the gentleman from Ohio,
Representative Landsman, for 5 minutes of questioning.
Mr. Landsman. I thank you, Mr. Chair. And I thank you all
for being a part of today's hearing.
To the Cullens, thank you for sharing your testimony. As my
colleagues said, it couldn't have been easy sitting here today.
I have a 13-year-old son. And I am just repeating what he said,
which is I can't possibly imagine, but what you are doing,
obviously, is making a difference in raising awareness and
getting those of us who are already passionate about this even
more passionate because of Zachary's life and you all being
here to tell that story. So thank you.
Couple of things. One is--and this is across the board,
anyone can answer it. But there are, obviously, concerns, and I
think in some ways they are bipartisan concerns, about the
funding issues. Hopefully, they will be bipartisan concerns,
because we have talked about all of these, you know, critically
important investments, Federal investments, recovery
investments.
In Cincinnati where I represent, we have the Addiction
Services Council. They do incredible work. So much of their
resources come from the Federal Government. The education work
that we have all talked about or you all have talked about.
PreventionFIRST! in our district does incredible work. Half
their budget is Federal dollars. We have a Quick Response Team
that has been incredibly successful, was featured in The
Washington Post a couple of weeks ago.
The worry is that you had--the freeze was put on hold or it
was stopped, but there's concerns and reporting about
workarounds. There is also, you know, potential looming budget
cuts. So I want to get to a place where sort of there is this
bipartisan appreciation for what could be taken from us. And I
was wondering if each of you could just say what the one or two
most significant investments, Federal investments, are that we
have to protect, starting with you, Sheriff.
Sheriff Bouchard. I think HIDTA is critically important on
this front, partnerships on that level, deconfliction and a
variety of things, but also how we fund task forces and the
kind of methodology. You know, there is a lot of discussion
which we have been a part of, and we look forward to a
partnership on that about forfeiture and equitable sharing.
That does impact our work in that space. Contrary to a lot of
information that is out there, there is no law enforcement
agency in America that is making money on forfeiture. It just
helps with some of the ancillary costs.
Mr. Landsman. I am glad you brought that up because there
is some discussion about, you know, changing those rules, but
the forfeiture money is critically important and then, as you
mentioned, how these task forces get set up and funded.
Ms. LaBelle. It is hard to answer just one because I think
they all work together.
Mr. Landsman. Yes.
Ms. LaBelle. But, you know, obviously, you know, the
Affordable Care Act, Medicaid expansion, the block grant from
SAMHSA, the SOR grant from SAMHSA, which is the State Opioid
Response grant which provides, you know, money to every State,
those are all critically important, and they work together.
Mr. Landsman. There is a whole host of law enforcement
grants and investments that go along with those too that I
would add to the list.
Any others that you want to point out?
The last thing I will mention is on the budget--the policy
questions. There, hopefully, will be a bipartisan border
agreement, and the work to stop these drugs from coming in has
to be way more robust than it is today.
There is this question about getting in front of--how does
Congress stay in front of the synthetic drugs. And you may have
mentioned it, but I am curious, just very quickly, what is it
that we should be doing that we are not? I mean, obviously, we
are going to pass this bill today, but, in general, how do we--
is it just the way in which the legislation is written that
matters most, or should we be sort of approaching this
differently? And I have only got 20 seconds, so----
Dr. Westlake. I think it is important to understand to make
sure that there is no innovation that is being harmed by
regulation. So to make sure--I know there is discussion about
testing strips and things, and there has been--you know, to
just make sure that the oversight that is being done isn't
hampering the critical research, because the problem is it has
to be nimble. Xylazine was an issue, and we talked about this 2
years ago, and, you know, it is still an issue. I started
fentanyl-related substances 8 years ago, and so I think that is
the--you know, is to watch for the unintended consequences.
Mr. Landsman. Yes, thank you.
Before I yield back, I think that is one thing, hopefully,
we can get after this hearing is a better sense of.
Thank you.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognize the gentleman from Michigan,
Representatives James, for 5 minutes of questioning.
Mr. James. Thank you, Mr. Chairman. And I also appreciate
the opportunity you gave me to introduce my friend and American
hero, Sheriff Bouchard, and for having this hearing.
Opioid addiction has impacted every community across
America, and it has especially hit the residents of my district
in Oakland and Macomb Counties. The previous administration's
policies left a trail of destruction, heartbreak, and broken
families in its wake, and now it is up to us to clean it up.
Simply going from 100,000 deaths per year to 90,000 deaths per
year is not a success we should be applauding. The number is
zero, and we will work continuously across the aisle to
continue to move in that direction.
Recent data from the CDC demonstrates that in 2024, 2,931
lives were lost in Michigan, in Michigan alone. That is the
number of U.S. servicemembers that died in 20 years in
Afghanistan, 200--I am sorry. 2,352 is how many people we lost
in Afghanistan, 20 years--more than a war's worth of death in 1
year in my State alone.
Previous year's data shows a trend of failed border
policies from a President that failed American families. The
rising tide of fentanyl-related tragedies has made it evident
that something is not working when it comes to stopping the
flow of illicit drug trafficking. And families in Oakland and
Macomb Counties continue to experience personal loss.
Highlighting this urgency for innovative and investigative
approaches is essential.
However one feels about tariffs, President Trump is right:
Our neighbors in Canada and Mexico must help us stop the flow
of illicit drugs entering our borders. No amount of
scapegoating and retaliatory tariffs is going to stop our
people from dying.
Sheriff Bouchard, can you please speak briefly to the
experiences that your officers have gone through in dealing
with the fentanyl and instances of overdoses in opioids that
you have seen?
Sheriff Bouchard. Thank you. We have seen an increase in
difficulty in bringing them back. That is part of the reason we
added Opvee to our tool chest, because we were seeing multiple
people we tried to resuscitate weren't responding on one or two
or even three doses of Narcan as you wait for the prescribed
time, things like that. We know that communication and some of
the prevention programs have been helpful, I think, eye-
opening, especially when we are doing them in high schools.
But it is important that we don't minimize or reduce our
focus on holding the people that are killing people
intentionally for profit accountable for what they do. That is
why in that one case I mentioned earlier, we prosecuted the
individual for causing the death, murdering the person that
died from the overdose. It's a poisoning. It is something they
did not anticipate, did not ask for, and did not want, and that
is murder, in my book.
Mr. James. One hundred percent. There are considerable
drains on your resources which inhibit your ability to fight
trafficking and confront emerging threats as well. What are
some of these drains on your resources? What are some of those
emerging threats? And what can Congress do to assist?
Sheriff Bouchard. Well, now we are getting into a broader
question, specifically above and beyond fentanyl, and that goes
to counterterrorism and the threat matrix that we are facing,
the threat picture that we see. And former Director Wray
testified multiple times that we are seeing more bells and
whistles now than we did on 9/10. As a member of the Joint
Terrorist Task Force and very involved in that space, we are
very concerned, and, obviously, that is drawing more and more
of our resources and attention to what things we may be facing
that we are not communicating about.
And I would encourage all of Congress to reexamine what we
are doing. It seems on many fronts we have lost some of the
lessons of 9/11. We are communicating less, sharing intel less.
We don't have a real-time ability to even communicate on it,
even at secret level, where you have got terrorists that are
communicating on encrypted apps and I am having to go find a
SCIF to get a brief on something that is emerging. We need to
figure this out and get back to understanding there is a real
threat facing this country on lots of levels.
Mr. James. So it is easier to conduct criminal activities
in this country than it is to conduct law enforcement
operations in this country?
Sheriff Bouchard. Absolutely.
Mr. James. And we need to fix that. I totally agree.
What specific resources, funding streams, or interagency
coordination mechanisms do you believe Congress should
prioritize to strengthen fentanyl trafficking and trafficking
enforcement, sir?
Sheriff Bouchard. I think it is important to, again, focus
on some of the programs that have worked. We are good with
examining and auditing programs to make sure that the money is
being properly and wisely spent, because in our agencies we do
that. We know that there is a limited pool, and it has got to
be spent appropriately and on the priority mission.
But for us in specifically the fentanyl space, it would be
the joint teams and HIDTA. That partnership and that
relationship, it grants the labs that can be maybe getting out
in front of some of these things and protocols on what our
folks should be doing on the street not only to save people but
how to handle anything they recover.
Mr. James. Thank you.
I would like a couple of seconds. I would like to recognize
Ms. Christine Szabo, who I witnessed save a life on a Detroit
street corner. For all of those who are invisible who are
saving lives, we see you. We appreciate you. Thank you for your
service.
Thank you all.
Mr. Dunn [presiding]. The gentleman yields back.
I now recognize the gentlelady from Illinois, Ms. Kelly.
Ms. Kelly. Thank you, Mr. Chair.
I want to thank Chair Carter and Ranking Member DeGette for
holding our first subcommittee hearing of the new Congress on
today's critically important topic. I want to thank all the
witnesses, and like my colleagues, especially to you, Mr.
Cullen.
In Illinois, the leading cause of pregnancy-related deaths
is due to mental health conditions, including substance use
disorders, which comprise 32 percent of these deaths. The
United States is facing a maternal mortality health crisis.
There has been a bipartisan focus on addressing and reducing
all causes of maternal mortality and morbidity, and I have been
pleased to work with several of my colleagues across the aisle
to pass important legislation to address this maternal health
crisis.
That is why I am deeply troubled at this administration's
actions since last week, when we witnessed a halt on federally
funded programs. I won't go through them because my colleagues,
you know, have talked about them, but I did want to talk about
my concern for deep cuts to the Medicaid program, including the
Maternal Opioid Misuse model, or the MOM model, which is
intended to address fragmentation in the care of pregnant and
postpartum Medicaid beneficiaries with opioid use disorder.
Dr. Camenga, in your work as a pediatrician, have you seen
that fragmentation of care can contribute to obstacles for
patients who seek recovery and support resources from opioid
use disorder and other substance use disorders?
Dr. Camenga. Thank you for that question.
I have definitely seen the impact of fragmentation of care,
both with children and teens and young adults and actually with
mothers. You have to go one place for mental healthcare, a
completely different system for substance use disorder care, a
completely different system for obstetric care, and then, you
know, a completely different system for the newborn baby.
So, you know, as a pediatrician, I will say, access to
resources for parents to improve their mental health is part of
what we do. In the clinic, for example, I do have a poster in
the clinic for our local State mental health access line for
parents. The reason pediatricians give this information out is
they come to us with newborns and asking us about their mental
health, and we love being able to connect them with community
resources.
So having these resources available as a pediatrician we
support because healthy moms, healthy children.
Ms. Kelly. And access to such issues. My district is urban,
suburban, and rural, and in some of my more rural areas, there
is not that access, and even in some of my urban areas, but it
is harder for people that live in rural areas to get to places.
Whether you are in a program receiving Federal funding in a
blue or red State, the consequences of deep cuts and funding
freeze will be very detrimental.
Ms. LaBelle, can you discuss what disruptions in access to
treatment and recovery services mean for patients and
particularly new moms?
Ms. LaBelle. Yes. Well, I mean, new moms have a higher rate
of overdose. And, you know, it is often hard for mothers, for
parents, to seek out treatment. So when they do, we shouldn't
make it harder for them to access that treatment, and
disruptions and confusion will make it harder for them to
access the treatment.
Ms. Kelly. And then how important is funding for HHS
agencies like the CDC and NIH in informing our understanding
and response to access, immediate threats as they occur at the
State and local level?
Ms. LaBelle. Yes. I mean, these funding sources are
lifesaving to, you know, hundreds of thousands of people,
millions across the country.
Ms. Kelly. I want to thank you for your responses. And,
hopefully, my colleagues will recognize and we can work in a
bipartisan way to make sure that the funding that is needed
will happen.
Thank you. And I yield back.
Mr. Dunn. The gentlelady yields back.
And I now recognize the gentleman from New Jersey, Mr.
Kean, for 5 minutes.
Mr. Kean. Thank you, Mr. Chairman. And thank you to all of
our witnesses for being here today.
The increasing prevalence of xylazine in the United States
is a dangerous trend. Public health officials have warned of
the skin wounds that can occur from repeated use of xylazine
and the risk of worse health complications if the wounds are
left untreated.
How much are healthcare providers aware of the dangers of
these health complications and how best to treat them, Dr.
Westlake?
Dr. Westlake. Yes. So I just actually saw a patient with
ulcers from xylazine about 2 weeks ago, and I asked him why he
was doing it, and he knew the risks associated with it, and he
just couldn't stop himself because he liked the high too much.
I mean, the issue is that the xylazine is available, and, you
know, it is not scheduled. It is legal to get it shipped in
now, and so that needs to change, you know, whether it is
placing it as a controlled III schedule drug or placing the
same restrictions that schedule IIIs have on it as far as being
imported and monitoring it. Treating it is--you know, treating
the ulcers, it is difficult, but it is--the problem is that it
is there, that it is happening.
Mr. Kean. So what steps can policymakers make on the State
or the Federal level to increase the awareness of xylazine-
associated wounds and treatment options amongst healthcare
professionals?
Dr. Westlake. Yes, I think just encouraging the awareness.
I think there is a pretty broad awareness of it now, but I
think--and a way to get that done is to get it spread through
the local, like, specialty organizations, like American Academy
of Pediatrics, American Board of Emergency Medicine. You know,
it is not necessarily through Federal. It is spreading it out
through the networks that the doctors listen to.
Mr. Kean. OK. Thank you.
Sheriff Bouchard, in my district, the Morris County
Sheriff's Office partners with the county health department,
the mental health association, the Morris County Prevention, to
operate Hope One, which is a vehicle that travels to sites
throughout the county to provide services and support for those
struggling with addiction. At these sites the vehicle provides
immediate access to services, treatment facilities, and Narcan
training and kits. In fact, at least 177 of these Narcan kits
have been used to save a life in New Jersey. These sites are
staffed by sheriff's officers, licensed mental health
professionals, and certified peer support specialists.
Can you speak to the vital role that law enforcement has in
these holistic approaches to treatment?
Sheriff Bouchard. Yes, sir. Thank you.
It is critically important that we are all connected,
whether it is health prevention or law enforcement. As I
mentioned earlier, we are typically the first one on scene at
any situation. CBS, I believe national, did a story on one of
my deputies saving a woman in a Dollar General. You know,
typically we are around and spread through the community. Fire
departments or EMS comes from a station. Lots of times we get
there first, and those first 2 or 3 minutes may be critically
important to saving that life.
So that partnership, and then the handoff to followup care
and to prevention in the future, that is where our crisis
response unit and our partnership with the health department
comes in.
Mr. Kean. Can you speak to how drug trafficking contributes
to violence in communities and how law enforcement is an
essential component in combating illicit drug threats?
Sheriff Bouchard. Yes. You know, when you think about an
establishment, let's say a McDonald's, if it is an armed
robbery there, they are going to take the cash. When you have
got even a legal licensed facility, whether it is a pharmacy or
a medical marijuana or marijuana facility, they both have cash
and drugs. And so what we are seeing is the violence that are
directed sometimes at armed robberies or situations there are
much more escalated.
We had a homicide about a week and a half ago at one of our
licensed marijuana grow operations where they came in, just
barely creased the door and shot the individual in the face and
killed them and then stole 50 pounds of marijuana. So they tend
to draw attention for armed robbery and for ancillary drug
activity.
Mr. Kean. And earlier in this hearing you responded that
today Americans can get xylazine mailed to their house from
vendors in China. Can you walk me through how that process
works or any current barriers that exist of this emerging
danger?
Sheriff Bouchard. At this point I am not aware of any
barriers. We have been trying to get a State law passed to deal
with xylazine. It is still not scheduled on the national level,
so there is not a barrier to shipping or mailing something
direct to an end consumer that is not prohibited by either
State or Federal law.
Mr. Kean. And do you have any advice for how to combat this
international flow of xylazine in the United States?
Sheriff Bouchard. I think it needs to be scheduled. I think
we need a whole-of-government effort, as I said, nimble enough
to deal now with xylazine, but what is the next iteration that
is going to come down the pike.
Mr. Kean. Thank you. I yield back my time.
Mr. Dunn. Thank you. The gentleman yields back.
And I now recognize the gentlelady from Texas, Mrs.
Fletcher, for 5 minutes.
Mrs. Fletcher. Thank you, Mr. Chairman.
And thanks to Chairman Carter and Ranking Member DeGette. I
am glad to be back on the Health Subcommittee this Congress.
And I thank all of the witnesses for your testimony today.
It has been very helpful and important, and I appreciate your
perspectives, your passion, and your purpose. So thank you all.
During this hearing I have heard my colleagues on both
sides of the aisle express concerns about the overdose epidemic
and about combating illicit drugs in this country, and I think
that these concerns are sincere.
Ms. LaBelle, I think you provided a really important
overview of the interplay of complex challenges and the many
fronts on which we must combat the existing and emerging
illicit drug threats. But what we have seen in just the last
few weeks from the Trump administration undermines efforts to
address this challenge as you described them. ``Undermines''
isn't actually a strong enough word.
What the administration has done in the last few weeks is
really decimating our efforts and our ability to respond and
address these complex challenges. Certainly, efforts to disrupt
international supply chains requires robust collaboration with
law enforcement partners, so firing FBI and CIA agents and
outing them is making us all less safe and less able to combat
these illicit drug threats. Gutting the Federal workforce, of
course, affects not only those and other law enforcement
officers, it also affects the entire healthcare system across
the United States. Halting all Federal funding, including
funding for the NIH, the largest funder of biomedical research
in the world, which funds critical research on substance abuse
and addiction, also impedes our ability to respond. And as Dr.
Ruiz noted, the administration has also halted funding for
SAMHSA, Substance Abuse and Mental Health Services
Administration, the main government agency tasked with
improving mental health across the country and addressing
substance use disorders.
And following up on some prior exchanges today, the only
reason these funds are now available to grantees is because
multiple Federal courts have blocked the administration's
actions. And even though that freeze of funding has been
blocked, we are hearing reports today that the SAMHSA website
has been inaccessible. This website has critical resources that
can help our constituents find the help and support that they
need.
And our job as Members of Congress and as members of this
committee is to tackle these complex issues thoughtfully, to
tackle the things that we are talking about today and craft
legislation that helps address them, to find a legislative
solution to address the supply of drugs entering the country
illegally, to take measures to make the public aware of the
threats of these illicit drugs, to address substance abuse
disorders by expanding access to prevention and treatment
programs, and to find research--to fund research for new
treatments and new innovative ways to address the crisis.
We say we are doing that today with this hearing, but what
is this committee doing, what is this Congress doing to assert
its authority here over congressionally appropriated funds and
congressionally established agencies and programs as President
Trump and Elon Musk stop payments, eviscerate programs, and
fire qualified personnel?
Ranking Member DeGette noted that, in the last Congress,
Republicans failed to bring the SUPPORT Act to the floor. And
as a reminder, the SUPPORT Act was a bipartisan agreement that
would have extended scheduling for fentanyl-related substances
and reauthorized programs for the prevention and treatment of
addiction. It was included in the bipartisan continuing
resolution last December, but then Elon Musk tweeted that he
didn't like the CR, and that was that. There was no SUPPORT
Act.
So why are we here if Elon Musk can at any time substitute
his judgment for all of ours at a moment's notice without any
meaningful objection from the House majority? If we pass the
bill to address the overdose crisis, or any bill, how do we
know that the Trump administration or Elon Musk won't just cut
off any programs for any funding that we authorize?
I hope this committee will assert its jurisdiction to the
executive branch. I hope that this Congress will assert its
authority to the executive branch. As we have seen from the
testimony today, the stakes are too high for us to do anything
else.
Now, with the time I have left--which isn't much--I do want
to turn to something that we expect this committee to take up,
and that is Medicaid. And one of the current attacks on Federal
funding Republicans have outlined in their budget
reconciliation is a proposal to cut $2.3 trillion in cuts for
Medicaid.
So, Dr. Camenga, in your testimony, you talked about how we
should increase funding for Medicaid. Can you just discuss,
with the time left, how you think significant cuts to Medicaid
may harm our efforts to combat this epidemic?
Dr. Camenga. Cuts to Medicaid harm children. That is the
period in the sentence. Fifty percent of children are ensured
by Medicaid. That is how they receive healthcare. So AAP is
very concerned about cuts to Medicaid.
Mrs. Fletcher. Thank you.
I have gone over my time. I have a few more questions I
will submit for the record, but I thank you all again for your
testimony and your time here today and your work.
Thank you. I yield back.
Mr. Carter of Georgia [presiding]. The gentlelady yields
back.
The Chair now recognizes the gentleman from Oregon,
Representative Bentz, for 5 minutes of questioning.
Mr. Bentz. Thank you, Mr. Chair. And thank you, panel, for
your patience.
So I have a question on demand and a question on supply. I
will go to demand first. I am from Oregon. And in November of
2020, Oregon passed Ballot Measure 110, which reduced the
penalties for most possession of controlled substances down to
a mere violation.
Between that year, 2020, and 2022, the number of overall
overdose deaths in Oregon increased by 75 percent, from 797 to
1,392 people. Nationally, over the same period, overdose deaths
grew by only 18 percent. Deaths in Oregon from opioids
specifically increased 101 percent between 2020 and 2022,
compared to 33 percent nationally over the same period.
Prior to the implementation of Measure 110, emergency
department visits for nonfatal overdoses decreased by 4
percent. But afterwards, it was one of three States that
reported an increase rate of such visits.
Between February 5, 2023, and February 4, 2024, Oregon had
a rate of nonfatal overdoses more than 200 percent above the
national average. And Multnomah County, home of Portland, has
the highest rate of nonfatal overdoses in the Nation.
So, Dr. Westlake, would you recommend legalization of drugs
as a way to address the demand issue, the demand side of the
opioid problem similar to that in Oregon?
Dr. Westlake. Obviously, of course not.
Mr. Bentz. I noticed that you were on several groups that
are trying to figure out what to do about the supply side. It
appears that education is the answer, is that correct? Is
education the best thing we can do?
Dr. Westlake. It is a key component to it, definitely.
Mr. Bentz. And you are doing that in your State?
Dr. Westlake. Correct. Prescriber education and then just a
cultural education. I think even more about intoxicants in
general throughout our entire, you know, American culture, the
way that we approach alcohol and legal drugs, illegal drugs, I
think we have a drug issue in America that needs to be looked
at societally.
Mr. Bentz. You know, I am happy to say that Oregon
recognizes that it has not done it right, but they have not
corrected at all the damage being done by the failure to have a
control mechanism in place that gives you some way to prompt
people--if that is the right word--to actually go get care.
Because we used to have drug courts. We don't anymore. We used
to have people actually arrested. We don't anymore because the
law enforcement justifiably says, why bother? It's supposed to
be small amounts. No one knows, no one cares, because no one is
going to be prosecuted for it.
There is a law enforcement component to it, for no other
reason than to force people to get treatment. Is that in your
thought? Because we can't seem to get back to where we actually
were with drug courts.
Dr. Westlake. Many of the patients that I see that are in
recovery are thankful that law enforcement had to intervene and
got them to the bottom, that their bottom wasn't their death,
but their bottom was an encounter with law enforcement and drug
courts,.
Mr. Bentz. Right. Well, thank you for that.
I am going to shift back to the supply side. Sheriff, thank
you for being here. I have the good fortune of having a younger
brother who was sheriff in Oregon, now retired, and happy to be
away from the politics of the office, not that that is an issue
today before us.
But let me just ask this question. The Trump administration
just filed a lawsuit against Illinois and Chicago for being a
sanctuary State and city, indicating that under the Supremacy
Clause their sanctuary status is interfering with what the
Federal Government needs to do.
In Oregon, back in 2020--actually, it happens all the time,
but I will use an event in 2020 in my district--two cartel
member drug runners were picked up by State police and were
held until released on bail. But they were not, the State
police, allowed--because Oregon is a sanctuary State--to
contact ICE. They promptly disappeared. This was the third time
they had been apprehended. And there is no doubt they were
arrested with drugs in their car.
My question to you is, do sanctuary State status interfere
with your ability to try to address this issue, drugs?
Sheriff Bouchard. Well, I am speaking hypothetically since
we are not one.
Mr. Bentz. But you have some cities in your State I think
that are, but go ahead.
Sheriff Bouchard. So, absolutely, if someone is not
cooperating and sharing information about who they have in
custody, they may not know who they have in custody. We don't
have access to some of the Federal databases, so we may not
know, you know, what that person is or what they are wanted
for. And that goes to my earlier comments about Homeland
Security and communication and post 9/11, how that was one of
the key findings of the 9/11 Commission is we have to share
information, we have to partner better, we have to communicate
better.
Now, I don't think immigration enforcement is a local law
enforcement issue, but sharing information and cooperating with
other law enforcement agencies on their lawful mission is
important.
Mr. Bentz. I appreciate that.
I yield back. Thank you.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognizes the gentlelady from California,
Representative Barragan, for 5 minutes of questioning.
Ms. Barragan. Thank you.
Mr. Chairman, I just wanted to follow up on an exchange
earlier with Mr. Griffith. There continues to be a concern
about the freezing of the dollars, Federal funds that community
health centers have--either not have access to and some that
have shut down or reportedly shut down.
We did followup to call the New River Valley Health Center,
which is in Mr. Griffith's district, and we did not get an
answer. We did hear that they were one of many health centers
at risk of closing their doors. So just wanted to recommend
that the Member reach out and actually connect with them to get
that information.
And with that, I want to turn to what we have been talking
about here. I have the majority memo in my hand, and it says
the hearing is to combat existing and emerging illicit drug
threats. Part of the memo says, ``According to the DEA, the
Mexican Sinaloa and Jalisco cartels are the transnational
criminal organizations primarily responsible for manufacturing
and trafficking illicit fentanyl in the United States.''
Sheriff, do you agree with that assessment?
Sheriff Bouchard. That they are a key component,
absolutely.
Ms. Barragan. Yes. And so do you think that one step to
combat illicit drug threats like fentanyl should include
weakening the drug cartels?
Sheriff Bouchard. Weakening the cartels? Absolutely, yes.
Ms. Barragan. Great. Well, thank you. Are you familiar with
the Organized Crime Drug Enforcement Task Force, which is part
of the Department of Justice?
Sheriff Bouchard. I don't have anyone assigned to that, so
I don't know the inner workings of that particular task force.
Ms. Barragan. OK. Well, I am going to read from the
Department of Justice website about the OCDETF, which is the
short version of the Organized Crime Drug Enforcement Task
Force. It is an independent component of the U.S. Department of
Justice. It was established in 1982. It is centerpiece of the
Attorney General's strategy to combat transnational organized
crime and to reduce the availability of illicit narcotics in
the Nation by using a prosecutor-led, multiagency approach to
enforcement. And they investigate transnational organized crime
and money laundering and major drug trafficking networks.
It sounds to me like this would be pretty important in our
combating the flow of fentanyl across the southern border and
elsewhere. Yet we have--and these are going to go into evidence
in a second, into the record--a January 21, 2025, memorandum
from the Justice Department that is changing policy and their
priorities. And lo and behold, this organized crime task force
is now to prioritize immigration offenses instead of the so
very important work of combating the drug trafficking, of being
those that combat the transnational criminal organizations.
So, Ms. LaBelle, despite the facts, President Trump has
redirected Federal drug enforcement, particularly officers on
this Organized Crime Drug Enforcement Task Force, to prioritize
immigration offenses over gangs that deal with the drugs. How
do you think this will impact our law enforcement's ability to
fight the opioid epidemic?
Ms. LaBelle. Well, when I was at the Office of National
Drug Control Policy, we gave the grants for the High Intensity
Drug Trafficking Areas program, and we worked very, very
closely with OCDETF. And OCDETF is a key component of drug
trafficking efforts in the Federal Government.
So deprioritizing and kind of changing their priorities,
obviously, would have a big impact on our ability to go after
drug trafficking organizations.
Ms. Barragan. Thank you. The other thing that I have heard
to weaken drug cartels would be for the United States to stop
the trafficking of guns going to the drug cartels. Because in
Mexico it is very hard to find, and they are hard to get,
actual arms and drugs.
And there is article after article. And I actually even
have a Justice Department ATF report talking about the U.S. to
Mexico pipeline. We also have plenty of articles of how the
United States arms the Mexican cartels.
Sheriff, do you think the cartels would be weakened if they
didn't have access to guns and arms?
Sheriff Bouchard. Would they be weakened?
Ms. Barragan. Yes, that is the question. If they didn't
have any guns or arms, would they be weakened?
Sheriff Bouchard. I think if you could eliminate their
access to weapons, absolutely, they would be less lethal, but I
am not sure----
Ms. Barragan. Thank you, sir. That is what I was getting
at. If you don't have access, it is another way to weaken the
cartels.
I just want to end--and by the way, there is no action
being taken by my colleagues or the majority on doing just
that, to stop the flow.
I want to just take a moment as I end to thank
Representative Miller-Meeks on our work together on having
alternatives to opioids and having Alternatives to PAIN Act,
which we are working on closely together in a bipartisan
fashion.
Thank you. I yield back.
Mr. Carter of Georgia. The gentlelady yields.
The Chair now recognizes the gentleman from Ohio,
Representative Rulli, for 5 minutes of questioning.
Mr. Rulli. Well, thank you, Chairman.
And this question will be directed at Sheriff Bouchard. And
I appreciate you all and all the time that you donated today.
So I have listened for the last couple of hours with all my
honorable friends on the other side of the aisle and their
immediate point of focus to say let's just throw a lot more
money at this problem. It was an overall theme for the last 3
or 4 hours. Throw more money at the problem. Throw more money
at the problem. And Medicaid expansion was brought up.
So I was in the Ohio Senate for almost 6\1/2\ years, and in
Ohio we have the sixth-largest Medicaid expansion there is. We
operate on a general assembly of about 93 to 94 billion dollars
biannual general assembly, and about $44 billion goes to
Medicaid expansion, and the drug problem in Ohio is running
crazy.
I don't think that throwing money at problems is ever the
answer. I think you have got to get to the core root of it. And
there is a lot of hard work that is involved with that.
One side of my district last week, sheriffs in my district
pulled over a man who had discovered fentanyl in his trunk that
would be enough to kill 30,000 people. A small little county.
It sent shock waves through the county that that much fentanyl
was being trafficked right below their noses, to be honest with
you. That is more than twice the population of that county.
Sheriff, what other tools can we get to locate these drugs
when they are moving through these small counties? And is there
some advice that you could get with your expertise to help
these small county sheriffs get a better grip on this and
instruct their deputies how to proceed forward and keeping in
mind their safety?
Sheriff Bouchard. Yes, the detection is a tough one because
of the components. They are not as prone to, let's say, a K9
detection, and some of the things that we, say, historically
have used on corridors of trafficking.
In terms of education, we try to share--again, we are Major
County Sheriffs of America, so we try to help the smaller
agencies, whether they are a sheriff's office or a police
department, with our partnership and with our expertise. And
that then goes back to what we talked about, whether it is
HIDTA or other kinds of things. We need to work together--share
information, share resources, share capability, and technical
knowledge. And we do that a lot. But it is such an evolving
landscape. So sometimes they may not know what they have got.
As I mentioned, even me being one of the largest sheriff's
offices in the country, I heard about, a number of years ago
now, but xylazine. And I was like, I hadn't heard about that
and so went and had our lab go back and test things on the
bench, and lo and behold, it was there. So that is where robust
communication and the public health space, law enforcement, and
cooperation, communication is critical.
Mr. Rulli. Is there any websites or any periodicals that a
sheriff that is in a small town in Ohio that you could
perhaps--because I think a lot of them are watching this
today--that you could recommend for them?
Sheriff Bouchard. Well, I know that NSA, the National
Sheriffs, which represents all of them, they have a
publication. And then, again, we share information, the Major
County Sheriffs of America. We have a website, and we partner
and share information regardless of whether you are a member or
not.
So I would encourage them to either reach out to NSA or to
check some of the resources that MCSA has.
Mr. Rulli. Really appreciate that information.
Now I am going to have a quick question for Mr. Cullen. The
HALT Fentanyl Act, I support. I lost my cousin to addiction. He
was only 23 years old. I was in a rock and roll band, I lost
one of my bandmates to addiction. It is very personal. I can't
find a single family in this country that doesn't have somebody
close to them or related to them that has perished through
this.
Fentanyl and other opioids ravaged our district. Any
opinions from you--and sorry for your loss, sir--that you can
give Mom and Dad, especially when you hear, like, mom and dads
doing testimonies on Instagram or TikTok and they are talking
about a son of theirs that just tried to get a Percocet in the
mail, and they checked on him in the morning, and they found
him dead.
Is there anything you could--my daughter is going to
college next year. It scares us to death. Any advice for Mom
and Dad?
Mr. Cullen. Thanks for that question.
So we are raising awareness as much as we can. And that is
what we want this body to do. I have said before that I feel
like we are screaming underwater at times because the message
is just not getting out. We speak to people at gas stations, we
speak to people everywhere.
Don't be afraid to have a conversation. I think a lot of
times parents are afraid to have a difficult conversation, but
it could be a life-or-death conversation. So just talk. That is
all I can say.
Mr. Rulli. Do you think talking like, you know, having that
adult conversation, ``Hey, you know, I know you don't want me
to think that you are doing drugs, but even a little pill could
literally kill you.'' That is such a different thought process
that didn't exist 5 years ago.
Mr. Cullen. So what I often say to a lot of parents is--or
even to kids is, look, I don't mean to presume that you are
doing drugs, but you are going to be in a situation, you may be
in a situation where someone is about to do something that
could kill them.
So now I make it more personal, saying now it is not a news
item. You know somebody who lost somebody. And I make it more
personal that way. And I just tell them, I don't presume that
you are on drugs, but you could be in a situation to save
somebody.
Mr. Rulli. I appreciate that. Thank you, Chairman.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognizes the gentleman from New York,
Representative Langworthy, for 5 minutes of questioning.
Mr. Langworthy. Thank you very much to the chairman and the
ranking member and to all of our witnesses for their incredible
testimony here today.
It is hard to find someone in America who has not felt the
devastating impact of fentanyl or other synthetic drugs.
Whether it is a family member, a friend, a neighbor, this
poison is tearing through our communities in an unprecedented
rate.
I have sat and had roundtables with law enforcement
officials and health professionals throughout my district--
which I represent the western part of New York State and the
southern tier counties along the Pennsylvania line--and they
all say the same thing, that we are losing ground in this
fight.
Police officers responding to overdoses several times a
week, it is having a great impact on, you know, their mental
health. Community leaders are witnessing fentanyl-laced drugs
killing people at an alarming rate, even showing up in things
like gummies, as you have talked about here today, poisoning
children.
Enough is enough, and I am very grateful that we have--
finally have someone in the White House who is laser-focused on
securing our borders and holding foreign entities accountable
and providing our law enforcement with the tools that they need
to combat this epidemic. And passing the HALT Fentanyl Act
today is a huge step in that direction.
But with that, in the area of lab innovation, Dr. Westlake,
last year the Biden FDA issued a final rule that would regulate
lab-developed tests as medical devices, which would severely
hamstring definitive drug testing by stifling the innovation
needed to keep pace with what we are seeing in the streets.
The additional regulatory burdens could delay the detection
of emerging substances, allowing dangerous drugs to circulate
longer and putting more lives at risk and potentially
disrupting patient care. With the rapid rise of these deadly
substances, it is critical that our labs have the ability to
quickly adapt and stay ahead of evolving drug trends.
So, Dr. Westlake, can you speak to the importance of lab
tests and the innovation in this area when it comes to
detecting novel, illicit compounds?
Dr. Westlake. Yes, I think it is critically important for
labs and for science in general to be able to combat the new
emerging threats. When they talked about the fire, I heard
spigots, there's new spigots popping up all the time. If you
have to wait and go through a burdensome regulatory environment
to be able to detect those and to combat those, then that
doesn't do any good.
My experience at the State level, coming up and seeing what
the regulatory burden at the State level is, you know, at the
Federal level is as much or more. So I encourage any type of
regulation that encourages innovation when it comes to that
because it is a significant risk of delayed response, and we
need to be nimble. We can't be--you know, you can't be a
battleship that turns, it has got to be a speedboat.
Mr. Langworthy. Thank you. I think it is critical that we
don't stifle innovation. And that goes to many facets of the
Federal Government. When we stifle innovation, we deny
ourselves the potential of lifesaving new technology that would
revolutionize the way we can combat this epidemic.
Pivoting here to emergency room screening. Dr. Westlake, we
have heard tragic stories of young people dying from fentanyl
overdoes because they were not tested for fentanyl. The
detection of fentanyl in overdose patients who go to the
emergency departments is critical to saving lives and combating
this opioid crisis.
As an emergency medicine physician, do you agree that there
needs to be greater use of fentanyl screening in overdose
patients?
Dr. Westlake. Yes, absolutely. I think it pretty much
should be the standard of care for fentanyl to be the sixth--
there used to be a five-panel drug screening for drugs that you
would get at every facility when a patient came in if they were
concerned with overdose. And now most of them have gone to
fentanyl. And if they haven't, then they are behind the times,
and they should. And that--you know, definitely, that is
critical--the majority--I don't think I have seen a heroin
overdose in a couple of years, but I have seen, you know,
dozens of fentanyl overdoses that thought it was heroin. And I
knew that because of the drug screening.
Mr. Langworthy. Very important to know. Do you also agree
that it would be helpful for the Health and Human Services
Department to study the current frequency and benefits of
fentanyl testing in the ER and provide guidance on how ERs
implement fentanyl testing in overdose cases?
Dr. Westlake. Yes, I would be cautious with kind of
regulatory involvement at that, to make sure that it didn't get
in the way of something in the future. You know, there is a lot
of unintended consequences. But I think looking at and making
sure that the ground level should be, you know, the state-of-
the-art science should be including fentanyl and it should be--
definitely should be reviewed.
Mr. Langworthy. Well, thank you to all the witnesses for
your expert testimony and the role that you all play in
combating this opioid crisis. And my thoughts and prayers are
with your family for your terrible loss.
It is clear we must take a stronger action across the
Congress, across the Federal Government to combat this evolving
threat of illicit drugs, support our law enforcement, and
ensure that our healthcare system is equipped to save lives.
And with that, I yield back, Mr. Chairman.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognizes the gentlelady from Florida,
Representative Cammack, for 5 minutes of questioning.
Mrs. Cammack. Thank you, Mr. Chairman.
I would like to make a point of order and move to take down
words spoken earlier today.
Mr. Carter of Georgia. The committee will suspend. The
gentlewoman will state the words she wishes taken down.
Mrs. Cammack. Thank you, Mr. Chairman.
Our colleague Mr. Veasey stated that, quote, ``the Office
of National Drug Policy's web page has been wiped by President
Elon.'' That was his words.
And I would like to remind the committee, as well as the
chairman and our colleague, that no matter what Mr. Veasey has
read on the internet, that his statement is false. This
committee should set the record straight. And, finally, the
President of the United States is Donald J. Trump.
He would be correct to state the facts instead of having
hurt feelings.
So with that, Mr. Chairman, I would like to have his words
taken down.
Mr. Carter of Georgia. OK. In the gentleman's absence----
Ms. DeGette. Point of order.
Mr. Carter of Georgia [continuing]. I am going to
recognize----
Ms. DeGette. Point of order.
Mr. Carter of Georgia. In the gentleman's absence, I am
going to recognize Representative DeGette for her response.
Ms. DeGette. Mr. Chairman, first of all, under rule 17,
clause 4, this motion is out of order because under that rule
it must be made at the time.
Secondly, I find it extremely amusing Mrs. Cammack feels
compelled to come all the way back at the end of this very
important hearing on fentanyl to let us know that Elon Musk is
not, in fact, President of the United States.
And, in fact, the rules do not allow the words to be taken
down except for, quote, ``personal abuse, innuendo, or ridicule
of the President.'' Well, as she herself says, Elon Musk is not
the President, so there is no basis for these words to be taken
down. And I would urge the chairman to overrule her.
Mr. Carter of Georgia. OK. The Chair asks the gentlelady if
she wishes to seek unanimous consent to modify or withdraw her
remarks.
Mrs. Cammack. No. Mr. Chairman, no.
Mr. Carter of Georgia. No.
The Chair is ready to rule. The Chair finds the words of
the gentleman from Texas are not parliamentary because they
constitute personalities toward the President. However,
committee rule 17, clause 4 requires a point of order be made
immediately. Therefore, I'll overrule the point of order.
I ask that Members please remain respectful and refrain
from this type of rhetoric.
And I now recognize Representative Cammack for 5 minutes of
questioning.
Mrs. Cammack. Thank you, Mr. Chairman. And thank you for
recognizing that this committee should be above any attacks on
our President.
Thank you for the opportunity to be here to discuss these
existing and emerging drug threats. As a Representative from
the Sunshine State in Florida, we are all too familiar with the
consequences of open borders and how every town in America has
been turned into a border town and State as a result of open
borders.
Over 100,000 individuals have lost their lives to fentanyl
poisoning every single year. And should this have been an
airline incident where a hundred thousand people were going
down, it would have never taken as long in order to start
addressing it. It is absolutely infuriating.
And, sir, I want to express, as many of my colleagues have
here today, our tremendous sympathies and condolences for your
loss. Never should have happened in the first place.
The opioid epidemic remains a persistent crisis, claiming
lives at an alarming rate. Synthetic drugs like fentanyl have
become increasingly potent and pervasive, exacerbating the
public health emergency. And new substances continue to emerge,
often faster than our regulatory and enforcement framework can
adapt to. These substances not only threaten public health, but
also strain our healthcare system and law enforcement
resources. This hearing has been a fantastic opportunity to
look at the full scope of the threats and to talk broadly about
strategies that we can put together to address them.
Now, my first question is for you, Sheriff. I am actually
the wife of a first responder. My husband, Matt, is an 18-year-
career firefighter/SWAT medic, so he has been on the front
lines dealing with this. And we collectively have understood
for the past 10 years it is not a matter of if but when he
himself becomes a victim of fentanyl poisoning because of how
many people he encounters on a daily basis that are overdosing.
So given the rapid evolution of the synthetic drug analogs,
what technologies does law enforcement have to detect the
substances? You can touch on that very briefly. But, more
importantly, address if these mechanisms are sufficient to
detect the new and emerging threats.
As these drugs continue to evolve different strains, new
additives, it becomes very tough to test for them. So can you
talk about if we are keeping pace with the molecular changes in
the drugs, and what strategies are in place or what do we need
to adopt in order to have timely identification to keep our
first responders safe, and then we can properly schedule them?
Sheriff Bouchard. That is a complex, layered question. I
think a lot of that goes to the difficulty of us understanding
what has changed in a lab that is basically a nation-state lab
that has abilities and facilities way beyond ours. And they are
trying to dial in what is no longer scheduled and what they
think will be profitable or deadly or whatever the, you know,
adjective is.
So I think a big part of that is for us as a country to put
pressure on the countries in whatever way you and the President
deem is appropriate to let them know there's consequences for
doing that, for constantly sending things to America, whether
it is China or through Mexico with the cartels, that there's
real consequences for them to intentionally do that and keep
trying to stay one step ahead of our regulating or our
scheduling of what they just used to make a big profit on.
In terms of the technology and equipment--and it is hard to
say what we need because we don't know what is coming at us,
and that is a big challenge for us on the local level. As I
said earlier, I did not know we had xylazine in our lab until
we specifically went to look for it because I had heard it
being found in other States a number of years ago. So sometimes
we don't even know what we don't know until it is upon us,
because we have very well-funded nation-state adversaries or
cartels that are, obviously, very flushed with cash that can do
these things, and then they end up in our lab before we even
know it comes down the pike.
Mrs. Cammack. Thank you. And I am going to have a bunch of
followup questions for you. But in the interest of time, I am
going to turn to you, Dr. Westlake.
Given the increasing prevalence of fentanyl as analogs and
other synthetic opioids in overdose cases, could you discuss
the differences in treatment protocols for fentanyl-related
overdoses compared to other opioid analogs? And again, I know
we need to be sensitive to fentanyl and carfentanil being used
in medical settings, so if you could address that.
Dr. Westlake. Sure. The receptor that--yes, antidotes use
are the same, whether it is synthetic opioid or natural opioid.
The problem comes when they are flooded with massive amounts.
And in that case, you just need to use more of the Narcan.
There sure--there is some space for a more potent antidote.
Narcan works. You just have to get it to the person before they
are dead from not breathing. So the issue is getting an
interdiction of the Narcan to the patient or stopping the
patient from taking the poison and the deadly opioid to begin
with.
Mrs. Cammack. Now, what challenges do emergency personnel
face in quickly identifying the specific substances involved in
an overdose? And how would this ultimately impact outcomes? The
reason--where I am going with this is to our point originally.
How can we get ahead in making sure that when EMTs, medics are
onsite, are on scene, that if they are dealing with a patient,
they can test quickly so they know what to test for but how
they can best protect themselves as well?
Dr. Westlake. At the level in the emergency department you
just treat for the respiratory suppression that is there. A lot
of times we don't even know what people--what people are
overdosing from. So, you know, we treat there. We treat the
symptoms that cause the respiratory suppression. So you just--
you treat symptomatically. So it would be difficult to--it
doesn't kind of matter what opioid you took. What matters is
that we got you breathing again and that we got----
Mrs. Cammack. OK. Thank you. I yield.
Mr. Carter of Georgia. The gentlelady yields.
The Chair now recognizes the gentleman from New York,
Representative Tonko, for 5 minutes of questioning.
Mr. Tonko. Thank you, Chair Carter. And thank you to all of
our witnesses for being here today. And my condolences to the
Cullen family. You all bring an important perspective.
We are in the midst of an overdose crisis, and we need to
treat it as such. Now is not the time for half measures that
make us feel good or for outdated and unsubstantiated
stereotypes and stigmas that hold us back. It is not the time
to freeze critical funding for treatment and prevention.
I continue to hear from local providers that people are
anticipating cuts and, in turn, limiting expanding programs on
care that would offer lifesaving treatment for addiction or
access to public health resources like naloxone or fentanyl
testing strips that save lives.
I have heard from programs that are afraid that funding
will dry up and they will be forced to lay off staff and, in
turn, serve fewer people or shut down entirely. We know that
costs of such cuts would be lives lost, families ripped apart
by poison seemingly beyond our control. The American people are
watching Congress to see if we still consider treatment for
addiction and overdose prevention a priority, and I would say a
high priority. Let's not turn our back on them.
So we know that our justice system is a revolving door for
those struggling with addiction and mental health issues. Over
half of people in State prisons and two-thirds of individuals
in jails have substance use disorder. By allowing inmates to
receive addiction treatment and other services before returning
home, my Reentry Act would bring targeted treatment to those at
the highest risk of overdose. The Reentry Act would be a game
changer for reducing overdose deaths and suicides by allowing
all States to provide prerelease care to Medicaid-eligible
individuals up to 30 days prior to release from incarceration.
I thank the Major County Sheriffs of America and the
National Sheriffs Association for their strong support of the
Reentry Act.
Sheriff Bouchard, thank you for your efforts and many
people that have joined in the effort. Many people don't think
of sheriffs as playing a role in treatment for addiction. How
do you approach that, the role?
Sheriff Bouchard. Thank you, and thank you for that
legislation. As you know, our organization does strongly
support that.
Mr. Tonko. We appreciate that.
Sheriff Bouchard. You know, we have a role in treatment,
prevention, and kind of the next path forward on lots of
levels, because we are typically, again, the first to respond
when someone out in the community is having an overdose. And
then once somebody, for whatever reason, on a different level
is incarcerated with a substance use disorder, we have
medically assisted treatment in our facilities, we have a
Narcan vending machine as you go out, and you can take that for
free. We try to connect them with resources, to the extent we
can, with programs and funding we have for aftercare. Because
when you drop them back in the same environment, that is when
they are most at risk to recidivism in that behavior. And as
was mentioned earlier, the likelihood of an overdose is very
magnified to that population when they come out without
anything in their system, and they immediately go back
sometimes to look for that.
Mr. Tonko. Thank you. And I know that Oakland County Jail's
medication-assisted treatment, MAT, program has been praised
for its comprehensive approach to treating opioid use disorder
in jail, including medication access, therapeutic services, and
post-relief support.
How has the availability of FDA-approved medications along
with the support services impacted the effectiveness of the
program? And what measurable outcomes have you observed in
terms of inmate recovery and reduced recidivism?
Sheriff Bouchard. Yes. It is helpful to have, you know, a
continuum and choices that the medical professional can decide
based on that individual rather than one prescribed route. And
so we leave that to our medical professionals and the
individual and the treatment and care that gives us the best
path forward. And we have seen noticeable results in how
outcomes are achieved, especially when paired with partnerships
outside the building.
Mr. Tonko. Thank you. I see my time is near up, and I did
have questions for Regina LaBelle. We will forward those to the
committee, and I appreciate your response.
With that, I yield back, Mr. Chair.
Mr. Carter of Georgia. The gentleman yields.
The Chair now recognizes the gentlelady from Virginia,
Representative McClellan, for 5 minutes of questioning.
Ms. McClellan. Thank you, Chairman Carter and Ranking
Member DeGette, for holding this very important hearing. Thank
you to our witnesses, particularly Mr. Cullen. I add my
condolences. But I also want to commend you for turning tragedy
into advocacy and make sure that no one suffers the same
tragedy that you did. I really want to commend you for that
today.
We have seen in Virginia alone over 2,400 Virginians have
lost their lives to drug overdoses each year. Community health
centers stand on the front lines of this opioid epidemic
response, providing essential services of preventing and
treating substance use disorders, delivering primary care and
dental care, offering low-cost prescription drugs. And for many
families, especially in rural areas like the southern end of my
district, community health centers are the only option for
accessing healthcare and prescription--I am sorry, substance
use disorder treatment.
These centers can't operate without critical Federal
funding from the Health Resources and Services Administration
to pay their healthcare workers and keep the doors open.
On his first day in office, President Trump issued
executive orders silencing Federal agencies and halting all
communal--external communication. Then, Trump and Elon Musk
unleashed a sweepin, unconstitutional freeze on funding for
programs, including those supporting federally qualified health
centers. And despite several courts blocking this action, chaos
and confusion have ensued.
In Virginia, the funding freeze abruptly cut 16 of our 31
community health centers off from Federal funding. Some are
still struggling to regain access to these critical resources.
And just yesterday, the Capital Area Health Network, which
operates seven facilities around Richmond, was forced to
announce the closure of at least three locations and the
transfer of patients to other sites, increasing the workload on
those other sites and impacting their access to care.
This was entirely unavoidable. But Trump handed over
control to an unelected billionaire and let him work without
thinking through the consequences to our communities of rash
action.
I am glad to see bipartisan agreement on addressing the
substance abuse disorder crisis, but we have to make sure that
our healthcare systems have the ability to rapidly respond. We
have to demand accountability when they can't. We have to
assure that the damage that has been done on this important
healthcare safety net isn't done again.
So, Ms. LaBelle, I wonder if you could please explain the
role that community healthcare centers play in helping patients
access the full continuum of care, including on fighting
substance abuse disorders?
Ms. LaBelle. Yes, I mean, you know, nationwide we need to
make getting care and treatment easier than getting illegal
drugs. And that is one key role that these community health
centers play, is that they meet people where they are, they
provide a continuum of care for people, wraparound services,
and, you know, play an important role in reducing overdose
deaths.
Ms. McClellan. And can you explain how the backlog over
accessing payment systems paying the healthcare workers has
impacted our community health systems and what we can do to
address the backlog of care that patients particularly in rural
areas need?
Ms. LaBelle. I mean, there is obviously a real dire
workforce shortage in a lot of parts of the country,
particularly in rural areas. And these types of kind of starts
and stops cause a lot more confusion. And people who could
potentially work in those areas be recruited are likely not to
come if there is confusion or a lack of funding for their
services.
Ms. McClellan. Thank you.
And I will just note in my last 43 minutes--seconds, this
impacts urban areas, this impacts suburban areas, it especially
impacts our rural areas. And in my district, which is 2 hours
end to end, many people in the southern part of the district
have to go to the Southside Community Health Center, which now
is closed and sending patients even further north. And trying
to get time off from work to travel long distances to get the
care that you need only to be told your appointment now is
transferred further north has a real impact that we can't
afford that kind of delay.
I thank you for sharing the importance of community health
centers.
And, Mr. Chair, I yield back.
Mr. Carter of Georgia. The gentlelady yields.
At this time, I am going to ask unanimous consent to insert
in the record the documents included on the staff hearing
documents list.
Without objection, that will be ordered.
[The information appears at the conclusion of the hearing.]
Mr. Carter of Georgia. I want to thank all the witnesses
again for being here today. Especially you, Mr. Cullen, thank
you so much. You and Mrs. Cullen, your bravery, your courage is
admired. And we all extend our heartfelt condolences for your
loss. Hopefully that your testimony today can help to save at
least one life. And if that is the case, then it is worth it.
So thank you very much.
Members may have additional written questions for all of
you. And if we do, we would appreciate it if you could get back
with us as soon as possible with that.
I will remind Members that they have 10 business days to
submit questions for the record, and I ask the witnesses to
respond to questions promptly. Members should submit their
questions by the close of business on February 20.
Without objection, the subcommittee is adjourned.
[Whereupon, at 1:37 p.m., the subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
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