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tv   Senate Judiciary Hearing on Opioid Epidemic  CSPAN  December 20, 2019 6:35am-9:01am EST

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>> good morning, everyone. i would like to welcome you to today's judiciary. on encryption -- excuse me that's not the right one. tackling the opioid crisis a whole government approach and i'll go ahead and start with opening statements from the ranking member and myself and i believe senator durbin has opening remarks and will die then to eyewitness testimony as
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well. since 1999 more than 700,000 people have died from a drug overdose in the united states. increased opioid addiction and a production of deadly synthetic opioids have exasperated american staggering overdosed death rate. in 2017, more than 70000 people died from drug overdoses making it the leading cause of injury related death in the united states. of those, 60% involve prescription opioids and illicit opioid such as fentanyl. americans fared no better against opioid epidemic in 2018 when more than 10 million people aged 12 or older of abused opioid in 2 million people suffered from an opioid use disorder and on average 130 americans died each day from an opioid openers.
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we did not know that some cost and disrupted lives or untimely deaths from widespread misuse of prescription and nonprescription opioids but we know from our family, our neighbors and our friend who bear the enduring lost loved ones that the opio crisis is not over. we must continue contending with this crisis. that being said, we made great strides over the past three years to help combat the epidemic, congress has passed landmark bipartisan legislation directed to combating the opio crisis and most notably, the comprehensive addiction and recovery act in the 21st century care act both of which i proudly supported were signed into law in 2016. combine these two bills provided over $1 billion to combat the opio crisis. with an emphasis on increasing prescription drug abuse prevention and treatment programs, two years later
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congress passed the bipartisan support for communities act which is the most comprehensive anti-drug addiction and trafficking legislation in modern history. we cracked the support act to address every element of the opioid epidemic for manufacturers and distributors to prescribers and it users to first responders and recovery professionals. to date congress has dedicated $11 billion to tackle the opio crisis. with the largest portion of that funding granted to the department of health and human services. today we will hear from the ministration and the executive branch members that shape and execute the government strategy for combating the opiate epidemic. the office of national drug control policy, the department of justice, the drug enforcement administration and the department of health and human services. this hearing is important we think about the oversight where we have in congress to ensure the executive branch partners are properly stewarding the
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funding we have provided to them to clearly tackle the opio crisis. that said the federal government is just one aspect to combating the epidemic and we do not stand alone. curving opio crisis relies on widescale integrated solutions from all impacted impactors. so today during the hearing we have an opportunity to hear from key components of the private sector including the healthcare distribution alliance, national community pharmacists association community anti-coalition of america and drug policy expert from the corporation. together we anticipate a close and comprehensive review of our collective efforts to curb the supply of opioids and unnecessary prescription of opioid for evidence-based prevention, treatment and recovery services for opioid use
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disorder to identify future needs as state and local level and developed sophisticated and tailored solutions to the destructive and deadly crisis. before i turned to the ranking member and witnesses i like to take a moment to remind us all that america's drug abuse problem did not begin with opioid misuse, and will not and with the opioid crisis. in my home state of iowa, methamphetamine abuse has remained a persistent and problem. nationwide in 2017 almost 1 million people had a methamphetamine use disorder and reportedly clinically significant impairment including health problems, disability and failure to meet responsibilities at work, school or home as a result to drug use. this number is significantly higher than the 684,000 people who reported having methamphetamine use disorder in 2016. in 2016 alone my home state of iowa reported over 1500 child abuse reports relating to methamphetamine. not just in the home but being found in the child's body.
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ultimately americans are suffering from drug dependency. our loved ones are dying from drug abuse at alarming and distinct rates. opioids are priority today but methamphetamine and other dangerous substances impacting urban and rural community should and will be addressed going forward. thank you and now i will turn to ranking member feinstein for her opening statement. >> thank you very much. i think your opening statement up tale each other and i suspect the up to what i remember of the committee thinks. the question is, what to do about it. just last year, overdoses were 48000 deaths. to me that number is stunning. in 2016 life expectancy in the united states has fallen for the third year, largely due to opioid related overdose deaths.
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in the economic cost are just unbelievable, $700 billion a year. one of the reasons it grew is because a lack of education among medical professionals which has led to overprescribing. so we saw in many cases pharmacies were pill mills with turning out millions of pills to smaller communities regardless of medical necessity. opioid manufacturers and distributors, i believe, had a responsibility to identify and report the suspicious orders. but they did not. this problem was compounded by an adequate responses from the federal, state and local governments. the trip administration declared the opioid epidemic of public health emergency in 2017 but has only used three of the 17
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authorities triggered by the declaration, limiting its effect. the office of national drug control policy omd cp, failed to issue national drug strategies in 2017 and in 2018. the 2019 strategy did not include concrete goal for a five-year projection for a program and budget priority both of which are required by law. and according to the october 2019, department of justice id report, the justice department and dea did not initially use all of their existing authorities and resources. reduced quotas for opioids are whole registrants adequately accountable. the result was an opioid
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epidemic that evolved from prescription drugs to heroin and ultimately to fentanyl. there is little question in my mind that the initial response to the opioid situation was ineffective. how do we get back on track? i very much believe that any solution must include a whole government approach and we have got to use all available resources. the comprehensive addiction and recovery act enacted in 2016 laid the foundation for this approach. in another bill, the support a act, was signed into law last year. it built on the 2016 legislation is by authorizing critical agencies as well as prevention treatment recovery and enforcement programs and expanding research.
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this act also included a provision called the using data to prevent opioid diversion, this part of the law is designed to ensure that opioid manufacturers industry routers are held criminally and civilly liable for identifying and reporting suspicious orders of opioids. i happen to be the one offer that and i'm very much concerned that it's never been really enforced. so today, i am introducing new legislation to strengthen this law. and this legislation will require data on all controlled substances to be reported. not just opioids. in order to better identify suspicious orders, it will also require pharmacies to report all transfers of controlled substances to the dea each
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month. there is so much to do, the federal government has begun to do this, omdcp has established a number of interagency working groups including the national opioid synthetic coronation group. to monitor emerging trends and data. the justice department created the opioid enforcement and prevention effort to division and that's the opioid fraud and abuse detection unit under a new initiative known as j code focused on disrupting the online sale of illicit drugs. for its part, dea has increased its tactical diversion squad enforcement and administered of actions against negligent distributors and manufacturers. as a result of these efforts for the first time since 1990
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prescription drug related overdose deaths decreased. that is really good news. so there are things that we can do to save life and reduce addiction. the center of disease control and prevention has warned us of wave drug overdose epidemics is upon us. most of those suffering from addiction they tell us use more than just opioids, and 2018, cocaine, methamphetamine and benzodiazepines were present in nearly 60% of all opioid related overdose deaths. that is a stunning figure to me. so we have to take a good look at it and see what we need to do
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and i would encourage our witnesses today to comment on this and if you have a solution or a thought, i think we'd be very interested in hearing them. our country has been ravaged by an addiction epidemic and it cost tens of thousands of lives every year. so failure should not be an option. this is an important hearing and i so look forward to hearing from our witnesses and hopefully with new ideas and constructive thought. thank you very much. >> thinking ranking member and i would recognize senator durbin for opening comments. >> thank you, madam chair for this hearing. i called seven a graham several weeks ago to consider this and i think him and you for making a possible today, i will not state again what's been stated, we can accept it, or in the worst drug epidemic in the history of the united states and losing an average of 2017 of 130 people
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each day. there is no time to smaller suburb to wealthy to escape this drug epidemic in my state across the nation. but it's not the first drug epidemic in our history. the crack cocaine epidemic showed, i hope we learned that we cannot incarcerate our way out of this addiction crisis, weenie prevention, intervention and treatment on the front and not just prosecution on the back end. there is a growing bipartisan consensus that harsh prison sentences have not only failed to stop drug addiction but created unjust and disastrous outcomes. i'm proud this committee spearheaded the first step act to right these wrongs. now we need to make sure as we combat current drugs on the market and the spread of synthetic fentanyl analogs that we do not impeach scientific research that can say people who overdose on these drugs and we do not criminalize any harmless substances in the process.
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let me ask you to consider this fact. a recent study of faunal overdoses in massachusetts from 2014 - 2016 found 83% of patients required more than two doses. more than two, why, because more lax on is no longer strong enough to stop and overdose. researchers have not yet identified an antidote that is. in a research and a more powerful antidote may include the drug fentanyl or some analog. that's what i'm proposing legislation that will allow the truly harmful analog to be added to schedule one but not at the expense of facilitating vinyl research to discover lifesaving antidote. unfortunately there's been an effort to bypass this conversation about the research aspect but i hope we can return to it. the second point is this, we can
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learn an important lesson from the 1990 tobacco master settlement agreement. the msa was landmarked $246 billion settlement to hold big tobacco responsible for hooking americans on nicotine. and get your bidding to millions of death, i might add there at it again with vaping. but only 8% of the dollars paid under that settlement were devoted to public health forms of nicotine addiction. 8%. most of the money was spent on unrelated items like roads, stadiums, many states, cities and counties sued the opioid industry in a massive lawsuit underway in cleveland today. that could produce a large settlement. i think it's critical that a substantial portion of the settlement be dedicated to fighting opioid addiction. third point is this, it was in june of 2016 in this hearing room at this very table that i learned food for the first time
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when the acting director of the drug enforcement administration revealed on the record it was actually the dea that approve the annual quota of opioids to be produced in the united states. opioid addiction starts with prescription keep painkillers made by pharmaceutical companies regulated by the drug enforcement administration. however, the inspector general and department of justice found, dea was slow to respond to the dramatic increase in opioid abuse and needs more fully utilized this regulatory resource. for years, dea permitted format to produce enormous ever-growing amount of opioid pills each year even though dea had the ability to set quotas limiting the production. for example, in 2017 the drug
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enforcement administration of the government of the united states of america allowed pharma to produce 13 billion opioid doses to be put on market, how much would that be? that would be a three week prescription for every adult in america approved by the drug enforcement administration. for years i've been calling on them to set lower quotas, last year senator kennedy in louisiana on the other side and i joined in a bipartisan effort to reform the law and required the drug enforcement administration to adjust opioid quotas to reflect the reality of what's happening in america. madam chair, i'm sure you're well aware of the county in your state, lee county on the border of iowa and illinois, lee county iowa averaged 45 opioid pills per person for nearly a decade dispensed by one pharmacy in that county. 45 opioid pills per person for
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every person living in that county for ten years. in hardin county illinois one of the least populated counties in my state about 4300 people, between 2006 and 2012, 2.7 million opioids were shipped to a fingal pharmacy in hardin county enough to provide every resident with 90 painkillers pills a year. the drug enforcement ministration is supposed to monitor this so that approve a massive production on the front end and no monitoring on the bakken, as we see these areas and counties being swamped with opioids. for years we've been calling on them to lower quotas now they have legislative authority and no excuses, unconcerned the dea is not taking this seriously as it should and will ask questions when we reached the point. dea has lowered and the quarters of years, dea proposed 2020 coders do not take into account
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drug addiction, overdoses and deaths in other words, the former production quotas don't look at the reality of the worst drug epidemic going on in america today. i look forward to working with my colleagues to continuing on a bipartisan basis to do with this. >> thank you. we will start with our panel one and we will introduce our witnesses and we will start with witness statements. with us today on panel one we have mr. chester, assistant director of national opioid and synthetic coronation group of the office of national drug control policy. in this capacity he leaves enter agency efforts to reduce the availability of fentanyl and synthetic drugs in the united states by distracting the global supply chain and we also have
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ms. amanda, she is director of opioid enforcement and prevention efforts for the united states department of justice. she is responsible for correlating the strategic responses to the opioid crisis including all investigative and prosecutorial efforts. we also have tim mcdermott, he was appointed as an assistant administrator of the diversion control division on july 24, 2019. he served as the principal advisor to the ministry or on all matters pertaining to the regulation and coronation of programs with the diversion of produce controlled substances. and please help me with your name, doctor period he serves as the chief medical officer as a mental health services administration. he's familiar with the development and utilization of medical services and nuance of regulation and across various state and provider perspective as he delivers direct patient
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care. thank you very much. we will go ahead and start with her witness statements and we will start with you mr. chester. >> chairwoman urns, ranking member feinstein and members of the committee, thank you for inviting me too testify on the dynamic and challenging opioid environment we continue to face in the united states. in the whole government approach to addressing it. the office of national drug control policy under the leadership of director jim carroll is uniquely positioned within the executive office of the president to courtney they ministration apprehensive approach to drug policy development and implementation. it began in the opioid issue the dominant threat was heroin. a relatively low crisis which allowed for not intervening use and heroin enabled an easy transition from prescription opioids to listen opioids. fentanyl emerged as a major overdose driver in 2015 initially as an adulterer to heroin but by mid 2070 many
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states have experienced or crossover were mo people were overdosing and dying from fentanyl then heroin exclusively. today we see more diversification across the opioid environment with a variety of fentanyl and non-fentanyl synthetic opioids readily available. some highly sophisticated counterfeit pills sold on the darknet and delivered direct to consumers. this is further complicated by user transfer among different drug types and across both synthetic opioids and non-opioid drugs like methamphetamine. combating illicit availability demands presidential leadership, strong bipartisan support from the congress and the synchronization of international state, local and tribal partners across the public law enforcement national security and intelligence communities. this allows us to deeply understand the environment in its complexity and identify and
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rapidly close gaps and capabilities as they emerge. over the last four years the government made lifesaving gains the synchronized approach first laid out in 2016 heroin availability reduction plan and the final report on the commissioning drug addiction in 2017. president trump's initiative to stop opioid abuse in 2018 and the 2019 national drug control strategy. we have the answer policy objectives along three clear lines of effort. prevent drug use before it starts, improve access to treatment for long-term recovery and reduce the availability of illicit drugs in the united states. most important, most importantly the strategy guides and synchronizes government actions on the entirety of the drug problem to achieve our goal of saving american lives. this is the only criteria that
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truly matters, the success of your efforts. these foundational documents and the effort they articulate and enabled contributions over the last few years was the creation of the department of justice with dark notes enforcement in the fbi targets the internet wrapping of synthetic opioids. the training and deployment of canine teams through customs and border protection through field operations specifically trained to detect fentanyl. the establishment of a 24 hour, forensic capability under the interdict act to identify new synthetic opioids as they emerge any market place and passes of the historic support act which recently authorized new medicare benefits that allow opioid treatment programs to build for their services, with medications beginning next month. the illicit opioid environment presents a daunting challenge. synthetic opioids in small
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quantities detecting and seizing these drugs, monumentally difficult as they move through the mail and across the borders. the increasing prevalence of drug users, counterfeit pills and the rapid emergence of highly addictive deadly and readily available synthetic opioids are impacting prevention and treatment efforts and as china's efforts for the initial production of fentanyl scheduling begins to take hold new production sources and distribution vectors are emerging. these challenges are not insurmountable. now more than ever our efforts must remain synchronized across the entire company, state, partners, partners in the private sector and others to produce the complementary effects we need to end this crisis. i want to thank this committee for your foresight and leadership in this law enforcement and public health challenge. on behalf of the administration
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we look forward to working with you. thank you for the opportunity to testify today and i look forward to your questions. >> ranking member feinstein and members of the committee thank you for the opportunity to discuss the opioid epidemic. i'm the director of opioid enforcement and my position was created for the sole purpose of ensuring the department is properly implementing resources to the fullest extent with the express goal of combating the opioid crisis and i have years of experience as a drug prosecutor, working as a united states attorney and deputy section chief in the department of criminal division. i know the department is not paying lip service when leadership stems the tide of this epidemic. it is responding aggressively
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and intentionally with every tool at its disposal. one such tool is focused on efforts to dismantle dark net websites that allow the most prolific drug suppliers to sell fentanyl in marketplaces. dismantling them is a priority for the department which is why the fbi established the joint criminal opioid enforcement team. since its launch there have been two large-scale takedowns that have taken dozens of darknet accounts off the web and hundreds of kilograms of drugs off the streets. the department has also been diligently working to prosecute mexican cartels who traffic fentanyl into the united states. the mexican cartels not only produce their own fentanyl but mixing it with other drugs like methamphetamines, heroin and cocaine which is contributing to the staggering numbers of overdose deaths throughout the country. that part of using all the tools at its disposal to combat these cartels most notably
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winning the conviction of or cartel leader who is sentenced to life plus 30 years in july of this year. another initiative's operation synthetic opioid surge that focus on illicit opioids in ten districts that have seen the highest overdose death rates in the country. prosecutors work towards prosecuting all readily provable cases involving synthetic opioids. over 300 cases were charged in these ten districts. additionally the towards created the appalachian regional prescription opioid strikeforce also known as our bow, a joint law enforcement ever that provides resources expertise of multiple agencies to identify, investigate and prosecute healthcare fraud schemes. since october 2018 the strikeforce charged 70 defendant's who were
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collectively responsible for distributing 40 million pills. these medical professionals were charged with drug trafficking offenses and stiff penalties and opioids. the strikeforce has worked hand in hand with hhs to ensure when there's a takedown of medical professionals patients are not left out in the cold, rather they are met by a team of public health officials who can represent a legitimate medical providers for dixon recovery services. the department recognizes we cannot prosecute our way out of this crisis and have been using our resources to prevent opioid abuse before it takes place. this occurs through school and community outreach partnership of native american tribes, public service announcements and training for medical professionals. additionally the department has a robust network established exclusively for opioid abuse and overdose prevention. this includes grants to facilitate treatment,
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prevention and victim services and help state and local law enforcement better investigate heroin distribution. i want to remind you what i spoke to you about in june, the importance of legislative solution for classwide sentencing, the nation has seen the usage of prescription opioid decrease the number of overdose deaths in the united states is reached record levels. one is the proliferation of fentanyl and its analogues. in february 2018 the dea responded to proliferation of fentanyl analogues by scheduling the entire class of fentanyl like substances on a temporary emergency substances. we have seen a significant decrease in encounters of fenton's is an reduced production of these substances by traffickers. classwide scheduling is working but the temporary emergency scheduling order expires in 51 days. as a prosecutor i can tell you
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legislation to permanently schedule fentanyl substances is a necessary step to continue countering this epidemic. we are running out of time. a solution is not found prosecutors will be hindered and traffickers will undoubtedly be helped. we cannot afford to move in the wrong direction of battling this crisis. thanks for the opportunity to testify today and working with congress to find solutions necessary to address the threat posed by this epidemic. >> thank you. mister mcdermott. >> distinguished members of the committee. on behalf of the 9000 men and women of the drug enforcement administration thank you for the opportunity to discuss our response to the opioid crisis. in the past several years our nation has been increasingly devastated by an epidemic fueled by the overprescribing,
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in the late 1990s in the first decade of the 2000s fueled by a fundamental belief that pain was undertreated in the united states. and discriminate prescribing created a generation of opioid users, presently made of 3 million americans. unfortunately as prescription rates have declined in the last four years we have seen a dramatic shift. mexican drug cartels filling the void with sheep, potent white powder heroin. they mix it with illicit fentanyl in the traditional form and in many cases counterfeit pills made to resemble illicit pharmaceuticals. dea is seeing chinese and mexican nationals working together to move massive amounts of heroin, fentanyl, fentanyl related substances across the southwest border. the profits these organizations are collecting is astounding. a kilogram of fentanyl can be
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purchased for $5000 from its sale in excess of $1.5 million. dea believes this in a lower cartel is the primary mexican cartel controlling the illegal drug distribution throughout the united states. these cartels do not explore boundaries in mexico, the united states or any other country. dea will focus its attention in an effort on command and control component of these major drug trafficking organizations to protect our citizens from the devastation they bring in the form of violence and drugs. with respect to addressing controlled substances and reception drugs i oversee the activities of dea's divergent program, roughly 18% of our workforce. the diversion of perception opioids by a small number of practitioners, less than a fraction of 1% have disproportionately impacted this epidemic.
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4 to 5 new heroin users state they started their cycle of addiction on prescription opioids. within the diversion program we realized criminal investigators and embed them alongside divergent investigators in an enforcement group of tactical die version. currently we have 86 of these groups nationwide who are solely dedicated to investigating, disrupting and dismantling individuals and organizations involved in divergent schemes. these groups along with an additional 87 diversion groups are using all tools administrative, civil and criminal to pursue those registrants who violate the law. we are focused on limits established for domestic manufacturing. with recent publication of 2020
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quotas, with ms. used opioids by 55% with level established at the end of 2016 and we bring down these quotas because doctors nationwide are writing less prescriptions for opioids. a 30% decline since 2017. despite these declines, we recognize opioids are essential medicines, dea will work with fda, centers for medicare and medicaid services and the stated aji offices to make sure there is adequate supplies. and outreach program with registrants aimed at improving communication and cooperation. thank you for the opportunity to be here today.
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>> ranking member feinstein and distinguished members of the committee thank you for inviting me to discuss the approach to the opioid crisis. i am chief medical officer for samsung. i'm addiction psychiatrist with expertise in multistate operations, provider supervision and treatment of mental illness and substance abuse disorders in underserved populations. the core mission is to reduce substance misuse and mental illness and communities across the country. where the agency within hhs that leaves public health efforts to improve the lives of individuals living with substance abuse disorders as well as their families. the number one priority in combating the opioid crisis is expansion of prevention, treatment, recovery, support services, by providing a full range of grants targeting the
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opioid crisis. the grants are sore, the program addresses the opioid crisis including prescription opioids, heroin and illicit fentanyl and fentanyl analogues by increasing access to medicaid using the 3 approved medications for treatment of opioid abuse disorder producing unmet need and reducing opioid overdose related deaths through provision of prevention, treatment and recovery activities for opioid abuse disorder. partnering with numerous community providers and other stakeholder organizations to ensure dissemination of appropriate evidence-based opioid strategies include drug take back and disposal programs and overdose education as well as no locks on distribution activities and media campaigns and strategies to reduce stigma. in order to ensure individuals receive a conference of array of services they provide recovery support services.
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one of the most common approaches by for grantees is utilization of pierce supports, individuals who themselves are in recovery. other common activities developed, enhancement and expansion of recovery community organizations as well as use of recovery residencies with peers are engaged in a number of sitting for individuals with opioid disorder initiate and maintain recovery. samsara believes the comprehensive systems of care through continued partnership between fentanyl governments, state and community use we will make continued progress combating the opioid crisis. american indians and alaskan natives were hardened by increasing rates of prescription and opioid use, addiction and overdose as well. these populations have the second-highest overdose death rates from heroin and the third highest with synthetic opioids. in an effort to address the opioid epidemic in indian
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country samsara has established the tribal opioid response through a source set aside. it aims to address the opioid crisis and tribal communities by increasing access to culturally appropriate and evidence-based treatment. samsara has been a leader to reduce overdose deaths, to reduce overdose by funding and technical assistance. samsara's overdose prevention toolkit released in 2013 is one of our most downloaded resources, this provides information on recognizing risks of opioid overdose, signs of overdose and how to provide emergency care in an overdose situation. toolkit is intended for community members, first responders, prescreen is, people who recovered from opioid overdose, family members as well as communities and local governments. samsara's opioid prevention experts targeting perception drug misuse of also shown
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positive outcomes. samsara strategic prevention framework prevention drug programs to target priority issue of prescription drug misuse. it opens with pharmaceutical communities on the risks of overprescribing to young adults and brings prescription drug abuse prevention activity education to schools, communities, parents, prescribers and patients. all the grandees are required to have an operational, state run prescription drug monitoring program that are supported in developing capacity and expertise and use of data from these pdm ps. the national survey provides key national and state-level data on a variety of substance abuse and mental health topics including opioid misuse. it is a vital part of surveillance efforts related to opioids.
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samsara is building existing partnerships, implementation of healing communities project. to improve pipelines and promoted to evidence-based practices and service delivery models. thank you for the opportunity to testify on this issue and i look forward to answering any questions you may have. >> thank you to our witnesses and we start with 5-minute rounds. i would like to start with neerja gandotra. according to the census bureau, rural areas cover 90% of the nation's land area and approximately 56% of iowans live in those rural communities. we heard from senator durbin outlining his rural communities. in your written testimony you highlighted substance abuse administration's work in those
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communities and thank you for doing that. describe the key challenges to reducing the impact of substance abuse and mental illness in rural communities especially when it comes to opioids. if you could also speak about methamphetamine as well. >> thank you for the insightful question. the focus is treatment capacity. we have a great number of providers that need to be in the right places. human capacity is addressed by a variety of different techniques. telehealth is one of the areas we are exploring to increase capacity to these rural areas and provider expansion. samsara in collaboration with the dea certified a large number of wavered positions and providers, by nurse
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practitioners in mid-levels, increasing provider limits so they would be able to have a greater number of patients. so that we attack this problem from different angles as well as including provider education of primary care colleagues as well, i would comment our addiction technology transfer center has provided 50,000 providers with expertise in attacking this problem as well. education and treatment expansion as well as providing opportunities with telehealth would be the ways we would most likely proceed. >> i appreciate that. in iowa i visited community health centers and they are expanding their reach through telehealth and appreciate you speaking to that. beyond the opioid epidemic,
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what is the long-term strategy for addressing substance abuse and mental illness in rural communities. >> the issue of addressing substance abuse, we have a lot of resources we are devoting towards that and we thank congress for the appropriation, the substance abuse blog grant funding in particular which can be utilized by treatment of any substance abuse disorder in addition to the sword grants which can be used to treat opioid abuse disorder and any co-occurring mental illness or substance abuse disorder. a great number of enrollees have substance abuse and mental illness and funds can be appropriate, are appropriated for that. >> mister mcdermott, dea is the nation's frontline for controlled substances and we
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recently marked the 1-year anniversary of bipartisan legislation which combats the opioid epidemic. i worked in that measure to strengthen drug take back programs, their efforts and safe disposal of drugs, how can dea work to increase participation in drug take back programs? may be hit or button again. >> i can tell you twice a year dea doesn't take that, once in the spring and once in the fall and it has been very productive. the most important thing i can say about this is when adolescence is involved with abuse of opioids it starts in the medicine cabinet and that is the most important thing to get out of your house, the
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things you heard about, if we could get the message out, doing a better job with participation of tribal areas and addiction rates are tremendous, in the denver area we covered montana and had serious concern so take back has been productive. we have more participation from state and locals and participation from coalitions and hospitals, you name it, we are out there and we have had a productive and at the end of the day there's criticism that we only get x amount of opioids, any opioids you take out of your house or off the streets it is beneficial. >> ranking member feinstein. >> thanks, madame chairman. i believe the chairman of this committee and i very much believe fentanyl should be made as one drug and hopefully proceed to do that.
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i can't believe 48,000 overdoses, overdose deaths, can you in any way give us the constituency for those 48,000 deaths? in other words, who is dying, what is their age, their race? how do we know who they are? >> one of the defining features, overdose deaths due to illicit opioids, it cuts completely across racial, economic, geographic, gender lines. a lot of the drug overdose abuse patterns we saw in years past are defined by the fentanyl crisis, introduced into the marketplace in different ways. sometimes as it is mixed in to
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heroin it lands in the existing drug using population. if it is pressed into a counterfeit pill and sold on the internet by an unknowing user who thinks they are getting cut rate opioids, it is a person who does not understand or know they are part of the illicit environment but getting a pill pressed, getting fentanyl pill being presented as a counterfeit drug. it cuts across all racial, geographic and demographic lines and that is one of the defining features of this crisis. >> what anyone on the panel not support fentanyl being scheduled one drug? i assume the answer is yes and madame chairman, i believe strongly and we have discussed this, it should be scheduled as soon as we possibly can.
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48,000 people dying from it. can anyone of us a discussion of the deaths and the majority of use involved in those deaths? >> i can start and others can fill in if they want to. one of the things we've seen in the evolution of fentanyl, i touched this in the opening statement, in 2006 there was a overdose death in illinois tracked to one single lab in mexico. it was neutralized and fentanyl didn't completely go away but it decreased and wasn't until 2015 the we started to see it be a regular feature in postmortem toxicology testing then drug seizures.
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by that time asian drug traffickers from china entered the scene and we are bringing in into the country principally over the dark net and said through mail and expressed and the reason i say that is rather than having individuals go to drug traffickers and make a face-to-face cash transaction it was now able to be diffused across the country and anyone with access to a laptop in the dark web and crypto currency could have it delivered directly to the house and this speaks to the proliferation of illicit opioids and fentanyl across the country. what was originally started in the northeast as it involved intravenous drug using population expanded across the country to where we are today. >> any newly discovered fentanyl substance should be added to the controlled
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substances act by name. would everybody support that? anybody disagree? we have our work laid out for us. senator durbin has thoughts on this. we work to schedule one drug and try to reverse these death. is there any common denominator, people in the 48,000 racially, economically, agewise? >> not too many but some of our state partners who provide a lot of information have spoken to an increase in the african-american community other than we saw in local opioids.
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the only common denominator is availability of the drug. availability we know leads to increased first use and first use leads to chronic use with opioids more so than any other drug in that -- >> you support making -- does everybody on the panel support making it a schedule one drug? would you like to comment? >> i would have to take that back to the department. >> i agree with you. >> i would like to take the question back. >> if you would i would appreciate an answer because that is where i am going and may not be successful but it is what i believe. >> senator grassley.
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>> the office of inspector general recently reviewed the dea efforts to the dye version of opioids. the dea was slow to respond to a significant rise in the use and diversion of opioids since the early 2000s so mister mcdermott, the inspector general's report states the department and dea agreed with the recommendations. how is dea prioritizing and meeting these recommendations? >> we are working on those. one is there was criticism of dea pertaining to our work plan for divers and investigators was we have worked with oig and
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implemented recommendations as we speak today. >> the next question is easy to answer. when you update congress on the progress of meeting these recommendations? >> yes, sir. >> last year congress passed landmark legislation, the support act. i'm proud to have cosponsored and moved through the judiciary committee, number of bills that are part of that law. the oig report states because the support act is new, the justice department is, quote, unable to measure or predict its effect on the opioid crisis or dea's opioid enforcement efforts. while that may be the case, the director of opioid enforcement
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efforts at the justice department can you provide anecdotal evidence of success of efforts to end the crisis? >> with respect to the support act. >> the dea has implemented a number of asks from the support act, suspiciously the suspicious order database implanted october 23rd of this year. they are working through a number of other ones in the support act to include the database that has been invaluable to the department with respect to opioid investigations. i have seen firsthand how the databases have been used to prosecute dye version of opioids with what we call dirty doctors to the nationwide opioid manufacturers so we are working to ensure we can hit
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those benchmarks with the support act. >> i will ask this question of the panel and i hope it doesn't cross over what senator feinstein asked. fentanyl ended to dangerous analogs from china which issued a classwide control of fentanyl analogs. earlier this year the department commented the judiciary committee hearing as they insure follow through. to all of you what significant developments show the american people the we are winning the fight against chinese fentanyl? >> i think a couple things have come together to bring some
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outcomes from china's efforts to schedule fentanyl. the first is the president's direct appeal to president xi was a game changer. his coordination with the administration and interagency has been important and resulted in china not only following through on its commitment but taking tangible steps such as two months ago inviting us officials to the conviction of nine individuals for fentanyl trafficking from china which was a major step forward. director carol traveled to china in september, spoke with the chinese government about tangible steps they could take about greater law enforcement coordination and the steps in china are positive and will take us in the path to reduce the flow of fentanyl coming into the united states. >> for the rest of you if you
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have an answer make sure because my time has run out and i don't want to infringe on other people. >> we sina drop off in analog coming through the mail which shows positive steps that have been taken from china's classwide scheduling and since the temporary scheduling order went into effect we have seen a significant drop off of analogs in the country. only two analogs that have been encountered in this calendar year which shows china's actions and the actions in the united states are working with respect to fentanyl analogs. >> i ago her comments. we have two offices in china the one in beijing and one in wong joe and the working relationship has been excellent. >> do you have anything to add?
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>> sams the's approach has been for projection and a quarter million distributed across the country with reversal of 14,000 overdoses. >> thank you, madam chair. >> i want to make sure the record is clear. in 2016 with a hearing before this committee and establish the drug enforcement administration approved the production of 14 billion opioid doses in the united states, 14 billion. that men's every adult in america could take a one month prescription of opioids based on the approved production quota from the drug enforcement administration. we still face it. opioids driving it to heroin infantile in the dea approving the function of 14 billion of these doses requested for the pharmaceutical industry. a number of us started asking
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what is going on here? are we producing these opioid pills, more than is necessary for the help of america? as a consequence, the quota productions have gone down. 55%. i don't know the exact number but i estimate 8 billion at this point, 8 billion opioid doses here. what is that equivalent to? it is equivalent to a two week dosage for every adult in america. that is what we are still producing and opioids as we talk about the consequences of the opioid drug epidemic and so senator kennedy and i said what is going on? is the dea paying attention to what is happening? the response to me was if you want us to pay attention, put it in the law and we did and we said from this point forward when they set the quotas at dea
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take into account deaths related to opioids, dye version of these opioid pills from the ordinary medical course of commerce and the following and so we went to see what happened and you know what the response was? we can't find that information, can't take that into consideration, the dea told us due to the grouping of drug classes the data cannot be used to estimate dye version, what does it take? how do we get the dea to acknowledge 8 billion opioid doses, dramatically more could be used for legal purposes, medical purposes. >> thank you for your question. as previously discussed by the former acting administrator dea realizes we could have done things differently.
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i've been in this position almost 3 months. i read your letter and senator kennedy's letter. i sat down with our folks that do quota and we went over the numbers. i assure you that is a priority for me and for the administrator to ensure we have a balanced approach and we are looking at those. if we look at the numbers we are doing what you asked us to do. >> 8 billion? enough for every adult in america to have an opioid those for two weeks, every adult in america, you think that is good response in the midst of a drug epidemic? >> we work with hhs, fda, cdc, state attorney general's office to ensure there is adequate medical supply, research and we will continue to work with your office and to ensure we have proper medical supply. >> if our government doesn't
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start by reasonable regulation of the production pharma will ask for more and more and more far beyond what is medically necessary or needed for chronic pain. if the drug enforcement administration is not in on the program we are going nowhere and i hope that changes soon. senator kennedy and i put it in a bill and we've not had response from dea that i think is appropriate. can i ask a question? is there an antidote to fentanyl? >> you mentioned you heard anecdotal reports where people required more than one dose as a reversal for opioids. at this time, that is our fda approved option. it has been used to reduce opioid overdoses. long acting substances like
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fentanyl might require more than one dose. that is why after someone had it administered and have been recess dictated they still require adequate medical supervision. to answer your question, it is the option we have. >> the scheduling of fentanyl analogs we discussed in a separate meeting. i'm not opposed, putting fentanyl analogs on schedule as they currently are and will expire in 51 days. what i worry about the what i'm concerned about is we do not have an effective antidote for fentanyl and what we are putting into the process is going to close out the possibility of research into an antidote for fentanyl which would be underway would be ludicrous to believe fentanyl
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would disappear even if the import numbers are coming down. in putting these analogs on schedule, give us some process so researchers can look for the antidote that can save lives today. it really doesn't have the effect of application that could make a difference. >> i'm proud to say that apartment of justice and health and human services have been working through the summer on the balance you talk about between controlling substances that are dangerous, allowing adequate research or access. we struck the balance and enjoyed working with the committee on this to ensure as substances are gathered up that
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are reasonably dangerous, we provide an unprecedented level of research or access to pull them out of the schedule for research purposes to do two things, to determine their medical merit, maybe the next generation of non-locks own or that they have no active effect on the body or they should be d schedule. the work that we have done between both of those department strike that balance very well with an unprecedented level of research or access but at the same time an unprecedented level of control for substances that are dangerous to americans. >> let's continue the conversation. >> senator blackburn. >> thank you to each of you for being here. i think you can hear the bipartisan frustration in our voices. we have an issue that continues to get worse, not better. in tennessee we have seen an
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increase in our drug-related deaths. 1837 last year, up from 1776. we know from our national law enforcement community that fentanyl related deaths are increasing. our tbi director has said he is seeing a continued increase. it is something we are facing statewide. we have a problem with fentanyl on the street and with meth, in upper east tennessee we engage regularly, constantly with law enforcement and healthcare professionals and this is why we need you all to really collaborate with us in a timely manner to find answers to this.
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senator feinstein and i talked yesterday how drugs and mental illness affects the homeless issue they are struggling with in many of our cities. we need to move past these discussions. we've been at this a while especially with the opioid. look at what is going to be a coordinated long-term strategy. look at how we are going to get resources to law enforcement in the hardest hit areas around our country and doj has commended the man's we commend them for the good work that they are doing and when it comes to hhs what are we doing
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to promote treatment for the thousands of addicts, people who are caught up in a revolving door situation with law enforcement, they are incarcerated and not receiving the treatment that they need. so mister chester i want to come to you first, amanda liskamm, what are you doing to get resources to law enforcement and i want you to talk a little bit about treatment and what you are changing to meet treatment and recovery available for physicians, what are you doing to train doctors, to educate pharmacists when it comes to this. the number of appeals in the system and being able to achieve the balanced approach, to get the rest of it out of the system.
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mister chester, to you first and please be mindful of the clock. >> i will be quick. when you talk about resources from the office of national drug control policy, principally the high-intensity trafficking program that funds law enforcement at the state level that are state, local and federal. >> a combined effort. >> absolutely. the thing is they are unique to the area and focused on particular drug threat in that area rather than -- >> they give me the flexibility necessary. >> doj we have a number of strike forces where we utilize the same methodology with state and local law enforcement like
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the appalachian opioid strikeforce. they are focused on efforts in the appalachian region, they have hhs and oig involved and they rely on local and state partners to combat the divergent of opioids in those areas. >> anchored in evidence-based practices through provider education. we have two main initiatives, the clinical support system which implemented data materials into medical school curriculums as well as provider education for substance abuse disorder within healthcare settings and education. we believe healthcare settings is the place where we can improve our scope for educating the next level and next generation of providers. >> we have utilize those programs.
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>> 50, over 157,000 individuals have been trained through both programs. >> yield back. >> senator whitehouse. >> let me start with a question about purdue pharma. i don't know if you were involved in that from doj but in august 2018 we sent a letter to the department of justice asking why the case against purdue pharma proposed as a federal criminal indictment out of the western district of virginia once it got to the political side of the department of justice suddenly got turned into a misdemeanor prosecution for find it in the context of this litigation is
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not significant and operated not against purdue but a holding company so it could continue to do business with medicaid and other federal programs. the fact that rudy giuliani was involved on other matters to the disappearance of this prosecution of the political level and first of all i would like to get an answer by 2018 and what you know about why that prosecution turned into a misdemeanor settlement. >> i can look into that letter. i'm not aware what the status is but i will take it to my colleagues. i wasn't involved in that. i can tell you the department is actively looking at nationwide manufacturer and
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distributors of opioids. we recognized the role of the executives contributing to the opioid crisis. >> you are in the multi-district litigation, if not a litigant. >> we filed a friend of the court letter. >> what assurance can we have that in your role as a friend of the court in the multidistrict litigation to the permit of justice will take a serious position in favor of the plaintiffs when the record so far you call the right lawyer and go to the political appointees at doj in your case disappears into a misdemeanor against a holding company. >> we are not party to the multidistrict litigation. we are simply there to provide guidance whether it is the court or plaintiffs in that case. >> where will the guidance go. >> it depends on what the issue
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is. we have been involved in helping depositions of dea, current or former employees. we've been acting to pull together the data requested as part of the litigation and -- >> supporting the discovery phase and information gathering phase of the effort and when you take a position will the same people who scotched the western district make the decision as to what position the department should take substantively? >> i am not sure what position the department will take a what the issue is going to be but i can tell you i reiterate the department has open investigations which i can't comment on but is actively looking at the space and trying to hold people accountable for their involvement in creating the crisis. >> abuse at a better job than you did last time.
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last question is more of a technical question but as you heard today there is broad bipartisan support for scheduling than fentanyl as an unlawful drug. however all of you seem to agree with that when we go to hhs this administration says no, we shouldn't do that because the chemistry in this question is very complicated and if you ban fentanyl analogs you will likely get into banning drugs that could actually help with addiction or with response to an overdose so it seems to me the most important thing you all could do is get the administration aligned behind the program how we schedule fentanyl without running into an objection from hhs.
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you can coordinate the effort. >> we have been coordinating between hhs and its departments, cdc, nih. >> is very common position yet? >> there is. the decision was in committee in september of the balance, when we talk about fentanyl i want to be clear what we are talking about is fentanyl analogs which are additions or substitutions to the sentinel skeleton reasonably assumed to be active in the body based on structure activity relationship. has these substances come in they are captured. the other side of that is to have unprecedented level of access to access those substances, do research on
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them, determine their actual activity and that is what we have done with the department of health and human services and the permit of justice bringing them together to get an agreement we struck the right balance between control and access and that is what we have presented to the committee. >> my time is expired, more to follow. >> you talk about opioids, that is an umbrella term including prescription drugs, heroin, fentanyl, what we consider opioids. >> it would include all of those synthetic and natural opium, her one all the way to prescription drugs as well. >> in your experience as addiction specialist when people can't get prescription drugs do they opt for a cheaper
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alternative like heroin? >> a subset of individuals, not everyone would but certainly a subset would. >> 15,000 heroin related deaths, it gets murky because frequently several of you mentioned mixed together which is deadly obviously. you mentioned no locks own which is ministered by first responders and others when someone is suffering a drug overdose, 14,000 applications of that drug last year successfully but that just saves the person's life, does not cure the addiction. >> we believe most addiction professionals believe treatment has to continue for next and
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time. one intervention won't be effective whether it is reducing the overdose and the no locks own administration is evidence-based practice, something we promote as a wonderful option of opioid overdose. >> you just made the point, the person remains addicted and need additional treatment and help. >> treatment should extend to the full-spectrum if the person requires detox, residential, outpatient, treatment has to continue. when patients stay in treatment we need other outcomes. >> to methadone or something like that. >> thank you for bringing that up his medication assisted treatment is the gold standard for opioid use disorder whether
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it be methadone, all 3 are fda approved medicaid assistant treatment so they were found to decrease overdose and approve social capital in particular employment, criminal justice involvement, homelessness and engage in other behaviors so getting patients in treatment is our goal. >> you discussed mental health issues. do you see substance abusers, people suffering a mental health crisis who seek to self medicate, is that a phenomenon that you see? >> that would be a subset of individuals, they are interactive, when one gets worse, and one gets better it can provide a conduit.
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there is a subset of individuals for mental illness and substance abuse disorders and others that don't as well. >> mister mcdermott, the one source of opioids we haven't talked about is the mexican drug cartels on the border, something your agency specializes in combating. i know there's a lot of outrage, justified outrage pharmaceutical manufacturers who overprescribed prescription opioids but it comes across our southern border from mexican drug cartels. >> correct. >> the sentinel transits through mexico from china. maybe not all of it but a
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substantial amount. if we want to get serious about combating the opioid crisis in america we have to get serious about border security and intervening or interdicting those drugs before the cartels smuggle them into the united states. do you agree? >> correct. >> the proceeds of the illegal drugs the proceeds manufacturer, illicit activities like human trafficking. is that an accurate statement in your experience? >> that is accurate. >> my time has run out. >> thank you, madam chairman and take it to the witnesses before us today. one of the things i wish the average american had time to hear is broad bipartisan ship of the approach of members of the panel to working with the administration on trying to address the nation's opioid crisis. 48,000 americans died of
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overdose last year. that is ravaged every state, every community at every level. any senator who is doing their job has been to funerals, parent groups, engaged in the public health community and tried her best to tackle this and you heard probably shared frustration about how slow some processes are moving like scheduling fentanyl and how much we seem to still have failed to grasp the crisis. .. way. you are the assistant administrator for the diversion control of the dea, is that correct? >> that's correct. >> i'm grateful for what the dea does in delaware and across the country, but we lost 400 people to overdoses last year. it was a 15% increase over the year before that and increase over the year before that and that. in a bipartisan effort to try to find something more that needs to be done, i've worked with senator cory gardner of colorado on a simple issue, knowing where the drugs are going.
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and as you've heard from several of my knowing where the drugs are going. as you heard from several of my colleagues,at senator durbin forcefully pointed out that we had a system that now for years since literally millions of opioids to towns that tiny little populations or pharmacies and interdicting that would strike you as a pressing go. we live and what would you could order a pizza package from amazon and know in real time by text or calls or e-mails if you want them exactly where your package is and when it's going to arrive. we have worked with dea for monthshs and months to try and t consensus on whether or not the dea wants real-time knowledge of where massive deliveries of opioids that are likely to be diverted happening. all of us are familiar with the story of a small town in west virginia that ended up with millions and millions of doses for a town that had just a few
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thousand residents. so if i could mr. mcdermott, does the dea have the ability to track shipments of opioids as the move from thehe manufactureo the distributor? do you have the ability to monitor that in real time now? >> we do. we enhanced our status. as part of the support act we had the source, and in october 21 of this you with that coming in. but to answer your question about real-time data, we monthly would be better at this point right now. we're still in -- >> so it is not real-time right now to answer my question. it's not monthly now. when do you get data about how large a shipment has made to a particular town or pharmacy? >> we received 30% of the manufacture and distributors to 30% on aon monthly basis. 70% on a quarterly basis quarterly basis and that's by statute.
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of the data but if i were in your shoes as a law enforcement officer i would want to get months after the deliveries. >> that's correct. >> senator gardner and i have introduced a bill, the suspicious identification act that would help you collect and analyze the data in real-time to ensure that you've got knowledge you can act on that state law enforcement can act on and pharmacies can act on them we see different manufacturers and distributors old honing in on one town and delivering millions and millions of doses. last year in math were shipped to my state of delaware to allow every single president to have 45 a year and i did the vast majority were not on the opioids last year. but 400 enough to die. one of the issues that has been focused on is three quarters died because of a mixture with fentanyl and i commend both our efforts to try to accelerate the scheduling of fentanyl and the
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steps china has taken, but there is so much more we have to do. let me ask about the ways we can and should be innovative around developing new methodologies for treating pain and addiction. i've also introduced with senator gardner of colorado the act that would support and fund critical research into the science behind opioid addiction that'that's already passed out e house and it was unanimously voted out of the senate commerce committee. i hope we will see a full senate vote on that soon. can you speak to which aspects of the crisis would benefit the most from additional research and before you answer i will mention we all just learned on t on a bipartisan basis there will be more funding for brain research, for the nih and more funding this coming year. where do you think we can make the biggest impact with more research? >> certainly anchored in evidence with the research support in all aspects,
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prevention efforts certainly have yielded through, treatment with the evidence-based practices that we already have, expanding one of the biggest ones we would promote as well as recovery services because treatment isn't just investing in the clinic also recovery communities. that's where the evidence lies and where i would expect the greatest to be yielded. >> i'm also pleased that the outcome it seems now the outcome of the appropriations process will be vetoing the cp will be received at the that they will have a modest i think disturbing increase in the height o of the fundinfunding and the drug-free community funding. folks, this is a genuine national crisis that demands all hands on deck at all of us engaged in finding the best ways we can to deliver the resources for the research, law enforcement and coordination of the federal and state level.
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>> thank you madam chair. i want to start by saying that for the state of misery, this is is a crisis that has been truly devastating. missouri's life expectancy in the state as a whole has actually been declining now for years on end because of the surge in drug overdoses, because of the surge in deaths and despair often linked to opioid addiction and other drug addictions. it's taking an enormous toll of courts around the country but in many ways it is groun ground zer this epidemic, so thank you all for being here and for the work that you are doing. let me start with you as the attorney general i brought suit against the manufacturers into the second or third state to do so. it was very early on, two and a half years ago ar were close to three years ago now. i understand that the district of new yordistrictof new york nn criminal probe of opioid makers and distributors and i'm wondering if you can get a sense of the scope with a stage of that investigation and anything
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you might know about where it stands. >> i can't comment on open investigations but i can point you to public indictments of manufacture distributor executives as of late with the executives of the other was a rochester drug corporation. we made a point of holding the executives in charge of these companies who helped contribute to the crisis responsible. >> i think that's very important to do and if that hypothetical or possible for the individual executives and some of these companies and major distributors may be investigated or charged. >> we will go where the evidence takes us but that is always a possibility. >> i'm glad to hear that and i hope that they will look very closely at that because i do think that if we are going to be charging opioid and heroin dealers and putting them in prison, and he showed, we absolutely sure that that is going to go all the way up the supply chain and i know from our
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own investigations in the state of missouri county outright deception of many of these companies, they knew that they were addictive, they knew what the side effects were, they knew that the data didn't support prescriptions and the mass numbers they were being prescribed and yet they deliberately misled the public sometimes doctors and veterans and other at-risk communities deliberately did so over a number of years and made literally billions of dollars and there's got to be an accountability in the wall for this. i want to come back to the question of drug smuggling and maybe i will address this to you. in the state of missouri and no, the supply of prescription opioids, the black-market supply i should say is being rationed down which is generally a positive thing, very positive. however we are seeing drug addiction continues to surge in the state and in the wake of prescription opioids we are seeing the black-market fentanyl and we've been talking about also methamphetamines.
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now those products are not produced in the state of miseryy and methamphetamine isn't produced in the state of missouri at mexico and it comes across the southern border and it's no to say every single one of our counties, 114, every single one of them is a wash in these illegal drugs and if you cannot go into a school in my state and not find these drugs with the snap of the finger so tell me about what our latest efforts are on the border, how are we doing it and protecting the drugs and what more do you need from congress because this is truly a crisis for my state. >> i was in missouri before i came back and so forth, so i totally agree with you 100%. i can tell you we are working with cbp. we have some of the highest seizures )-right-paren the united states on methamphetamine coming and i can tell you the men and women of the st. louis division work everyday to ensure
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the safety and well-being of the estate and i can tell that you have great professionals there and actually one of the best supervisors i had was right down to your area. we are adding additional bodies as well as when i was there we were able to get additional special agents assigned to the st. louis division, so i believe that we are doing everything we possibly can to work with our state and local counterparts as well as the department of justice, and you have some excellent u.s. attorneys in your state. >> what more do we need to do specifically on the border, however come and feel free to chime in here, you mentioned this in your statement. what has to happen to see the flow of these drugs? it is one thing we prefer to not have to deal with it a mistake. i prefer them not to come to the state to begin with and they are pouring into the state in springfield missouri for instance, we've had record numbers of overdoses and a two-month period more than a two month ago from wha from what loe
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fentanyl and potentially methamphetamine, then we had all of last year. that's unbelievable. the drugs are pouring in. what do we need to do to stop the flow across the border? >> you are absolutely correct the drugs coming from the mexican cartels whether they are methamphetamine, fentanyl or analog or devastating the country. i would refer you back to the class scheduling of defense and all analog that is our number one priority right now. we have 51 days left and we very much need congress to act on this. i think that is the number one request at this point. >> thank you very much and thank you madam chair. senator hirono. >> thank you. i know that we are here talking about opioids issues, but as mentioned by senator hawley and senator ernst other states have other problems in hawaii is mainly still methamphetamines. so, i'd like to ask you, let me
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give you a little bit of data on hawaii. the intensity drug trafficking areas 2019 threat assessment identifies methamphetamine, not opioids as posing the greatest drug threat to the region between 2012 and 2018 the number of people who die from overdoses increased by over 250% and over 70% of the drug-related deaths in hawaii or the result of methamphetamine and the problem is not isolated to hawaii. data from the centers show that overdoses nationwide increased fourfold between 2012 to 2016. what resources are your organizations and this is for the whole panel, or your organizations committing to address the increased use in states like hawaii and obviously in missouri and iowa and what additional resources do you need? >> i can start and then we can
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work our way down. it's beginning this year director carol have spent so much time traveling around the country and heard from so many members of congress and realized we'd have so much effort into the crisis and write so that we learned a lot and developed a love of architecture and we should apply that to methamphetamine is also the ram on a deliberate effort right now to gather the information and bring together the inner agency and come up with some tangible solutions that we can do about methamphetamines coming and i had a good conversation with the u.s. attorney from hawaii talking about where he beauties it is coming from i and what the patterns are and it's not only the problem of the drug itself but its criminality of count of trafficking that is deeply affecting hawaii. so we are working to find tangible solutions, whether that is using grant money that is specifically meant for opioids and expanding that to methamphetamines as well and as it was mentioned earlier the drug-free communities program
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are all ways that we can understand that this is a problem across the country. it's not geographically locatedd and we can take a lot of the stuff we've learned from this crisis and apply it to them for domains as well and they will yield back. >> with respect to the grants there are many out there that are focused on the opioid crisis as they should be but we have been hearing increasingly but there is the need to get money to help address methamphetamine and i recognize what a huge issue it is in your district. i can't point to wha you to whas happening with the mexican cartels and they have been for several years and continue to. it's a very profitable and easy for them to make there's a huge profit margin and it's through the roof and close to 100% so it
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is an epidemic and something we are continuing to work with and i think they can speak some of the programs, but i know that we are looking at domestic trafficking routes and how we can best attack the cartels that are bringing this into the country. >> do you know how most is comincoming in through the mail, through the ports, do you know? >> what i've heard is that it's coming in through both routes and they are doing what they can to address it. my understanding is that there is very little opioids in hawaii and that it barely methamphetamines compared to some of these other districts and so we are working on ways to help with that in terms of stopping the flow of methamphetamines into that state. >> have any of you come up with something very specific with regards to stopping at coming into hawaii and also what kind of treatment options there are for the states like hawaii?
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anything specific? >> they can speak to the great work they are doing with the government to identify. >> two things to answer one of the previous questions. the administration in 2018 provided us with funding for over 400 task force officers from state and local but know the area and know what's happening on the street level. so we've been able to implement that. as for the opioid crisis. however, due to the fact they are working cases now are methamphetamine as well so we have seen the surge in the task force positions as well as we have 11 offices in mexico right now. the primary office is mexico city and we are working with the mexican government on a day-to-day basis to take out the methamphetamine labs and we are working with them on seizures as
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i said in the united states and we are also looking at high-value targets to be brought back to the united states and face justice here. >> my time is up, but i would like to set a question regarding prevention because it is one thing to keep them from coming into the country but it's another one to see what we are doing to prevent the usage of the drugs especially among young people. thank you. senator kennedy. >> it seems to me we've got three problems here. people in china are addicting our people here in america. people in america o are people rather in mexico over addicting the american people, and the united states government is protecting the american people.
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senator burr been talked about the current quota being 8 million doses of opioids a year is the right of? >> by his method, yes. >> that's 25 vicodin tablets for every man, woman and child in america. if i take 25 vicodin over two weeks, i'm going to get addicted car and i? >> probably, sir. >> yes. so, we can agree then that is too high, right clicks >> i wouldn't agree on that. what i can say is -- why not ask >> because it depends on the medical use. >> i understand and we know the medical use is come is 25 vicodin tablets for every man, woman and child in america. you don't think that is too high a tax >> our quota is based on what we
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think is necessary for the medical and research -- >> and you think we need every one of those vicodin tablets? .. >> the quota we believe is an
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appropriate malevolent law - - balance for what i discussed cinemax you are saying yes? i don't speak be s. you are saying yes? right quex. >> we believe that quota is appropriate. >> let me ask you this. you give information about what pharmacist are prescribing quarterly and monthly in some cases. >> we with the distributors that are to the pharmacist. >> i think we just said the same thing. >> if you see a pharmacy population 1500 just prescribed 7000 tablets last month that tells you something
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right? we can agree that's too many. >> what you are describing is the pmp data we have the data that goes to the pharmacy. >> why don't you go get it? >> we have to get that from the state if we could ask for your assistance that would be a game changer. >> it doesn't seem like that's complicated. if a pharmacist is running scripts for 5000 vitamin tablets then we have a problem. >> i agree. >> you say who is prescribing all this? if you don't stop it. >> i agree. >> why don't you do it? >> we don't have the data. >> you don't have the data. you don't have the data.
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let me ask you something. you are a smart man. you are telling me you have to go out and educate the pharmacist that if you take too many vicodin tablets you will get addicted. you talked about evidence-based practices so the average doctor in america doesn't understand that if you give somebody six month supply of vicodin they will get addicted? we have to educate them for tha that? >> we are talking about enhancing the wider curriculum. >> stop. i barely got through the part
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i know if you give somebody a six month supply of vicodin they will get addicted. why do we do something to the doctors that are doing this? they don't need evidence based training they have been to medical school. i am over. >> thank you madam chair. as you can sense there is some anger and a little bit of fury about the opioid crisis and with all due respect i know you are the messengers and not the policymakers but our message to you, i thank you can sense it is one of frustration.
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and as my colleagues have expressed don't think it's good enough to say that mister mcdermott will work with you because that's at the agencies have been saying to us if so you should tell us but the crisis has existed for some time going back to connecticut's rate of addiction to overdose 2018 it was 1017 and that number is expected to rise with a
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221 percent increase in opioid -related death. so i think there has to be an effort not only the mexicans in chinese but the distributors and senator kennedy raises a valid point numerous times since my four children had all athletic injuries they were prescribed 30 days worth of opioids and the first thing my wife and i did was tell them they were not getting any of it. even rotator cuff surgery i was prescribed about the same length opioid i didn't even bother filling the prescription. but yet now there are courses
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in medical school on pain management so they are recognizing their responsibility. i think the manufacturers and distributors can help but in terms of the consciousness about this issue and politicians that took bribes from cartels. has the level of corruption diminished? >> depending on the country are looking at their different levels of corruption. one reason i spent a great deal of time on those cases it
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allows them to operate carte blanche. >> but you see no levels of diminishment of corruption. >> personally i have not. i have not been as actively involved in those investigations in my current role. >> how do most of the cartels shift the drugs into the country? >> from my experience i have had an opportunity to sit down with numerous or former members of cartels that are now cooperating who describe routes such as tunnels they spent $1 million to build under the border, to using a passenger vehicle, a truck with hidden compartments , lawful ports of entry, i prosecuted cases in california
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a fishing boat with an outboard motor is used to traffic drugs through maritime methods through the southern california coastline. they will do whatever they can to get drugs into this country to make as much profit as possible. >> a wall is not likely to stop them. >> i don't know. i think they utilize every method that is possible to get the drugs into the country. >> you mentioned ports of entry, tunnels, water route routes, none of those would be prevented by building a wall. i will not press you on this point because they recognize the limits of your appearance here but i appreciate your testimony thank you. >>. >> when we think about the
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wall which many people describe as a monolithic structure or fence along those lines and in other parts of the southwest i believe we are talking about updating the legal ports of entry and also building structures we also have discussions about funding coast guard so they can better beef up their efforts to secure the border do you believe looking at those drug trafficking having that scale that concept at one - - of a wall would have had an impact?
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>> the department can use every possible tool available for drugs coming into the country's all those tools would be beneficial to help stem the flow. >> me to. thank you happy holidays. something that i think is positive coming out of the dea just prescribing opioids over schedule to i appreciate the efforts i am curious with the data coming out of your agency i'm not seeing the same focus with other agencies and government do we know when they will catch up with the policies you have already been moving sharing senator kennedy's concerns with the
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prescriptions but they are opioids but potentially less addictive so first thank you for that. >> we are working on a daily basis with hhs with fda and cdc and the whole body government to ensure what's best for the us citizens senator kennedy and senator durbin we will continue to work. >> you have done good work and you should be commended for it. it is my understanding working on this as a matter of state policy with the states that
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have implemented policies those that are prescribing opioids minimizing the amount by some sort of oversight it's my understanding one of the leading causes of suicide in the country or people experiencing chronic pain conditions. >> i don't know if it is the leading cause that it is a major cause. >> the only medication that has efficacy of chronic pain that's why they prescribe it word you agree with that? >> you take a thoughtful perspective individuals of chronic pain in particular may
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develop opioid dependence but not those other dependent cdc has issued guidelines and i believe they will be revising those when it comes to provider education i would like to provide some clarity the improvement of those individuals and we try to implement evidence-based practices when it comes to medical school curriculum with opioid use disorder not just to prescribing practices. >> you said you would love to get the data from the state is not like you can just call up the health department to say you need this information you need statutory support? >> that's correct. >> what does that look like?
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>> i would ask you make the states have to provide us because that could provide the insight that senator kennedy would like you to have absent congressional action we don't have that. >> we do not we have to go state to state and then we have to sue the states to get the information. >> thank you. you mentioned evidence-based i agree with you treatment and recovery programs enforcement actions and as vice chairman of the senate appropriations committee the bill filed late last night in the budget package one.$3,000,000,000.110
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for rural communities, 500 million for research of paid management and pregnant and postpartum women 89 for a medication assisted treatment for prescription drugs in opioid addiction if you disagree with that money in there please say so i think the senators of both parties we have a lot of progress for my state of vermont we still
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have problems the university of vermont that is also in the burlington area and in the rural areas two hours each week for a treatment if the healthcare professionals prescribed for addiction just like they do medication. >> certainly has the treating opioid use disorder we would support any further expansion
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for all treatments and for vermont one of the first to implement where individuals would initially get treatment at a specialty site then continue had a spoke center so certainly we would want to not only do that but also telehealth options as well. >> we appreciate that because that brought our numbers down considerably. let's work together on this we can talk and agree on this we have to make sure that it happens the chinese government took steps to prohibit sentinel coming up on - - fentanyl targeted sacs
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sanctions make a difference to fenton now being shipped to north america. >> senator we have seed decreased direct from china shipments into the united states at the positive step in the right direction but what we do have to watch is if it's coming from another country like canada or a european country and an increase in the production of fentanyl in mexico and the southwest border with other plant -based drugs we are putting emphasis on that so all china's actions have had an effect we have to make sure they contribute to solve the problem. >> you mentioned the
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importance of written testimony the administration on the task force of all funding including 5 million for the state drug task force if these are important and why are they considered critical efforts for the epidemic? >> senator i'm not familiar with those figures but i can tell you that i've mentioned a couple of them the task force and initiative that have come out over the past couple years to stem the tide on this epidemic so i'm not familiar with that specific grant
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budget but we are trying to put our resources where we see results. >> i have some follow-up questions on that to keep that money in the appropriations bill. that's where the money has to come it started in the president's budget but it's more difficult. >> senator kennedy asked for an additional 30 seconds. >> i know you are new but explained to me in english why every man woman and child in america needs 25 doses of opioids every year. i know you work hard at what
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you do doctor. i have two brothers who are physicians but doctors need to police themselves. you will not convince me that someone is smart enough to go to medical school doesn't understand that if they give someone a six month supply of vicodin they will get addicted and the doctors need to police themselves. >> at this time we are ready for our first panel as we set up for the second panel will be the bios of the second panel thank you to our witnesses for being here today thank you very much. >> with the second panel we have doctor bradley doctor hauser doctor stein is a senior policy researcher for
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rand corporation practicing adolescent psychiatry policy researcher at the rand corporation and as a professor of psychiatry at the university of pittsburgh executive vice president miss kelly oversees all state and federal regulatory and political activities doctor hauser is the vice president of policy and government affairs for the national pharmacist association and over 25 years a private consultant in policy issues related to substance abuse to treatment into the witnesses on the second panel i will ask you to hold your statements to
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one minute and then we will make sure your entire statement is submitted for the record then we will proceed with questioning after that we do have votes that have been called so quickly go to your statements that would be helpful. >> good morning and ranking member feinstein with the practic seeing child psychologist in pennsylvania many are children of crisis as parents, siblings and aunts and uncles my clinical work is how the opioid crisis involves analgesics and treatment and touching multiple systems involving child welfare and public housing and the systems
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track very complicated ways to understand these interactions of the unintended consequences if we were to confront this successfully. we have made great strides with the pain pills for example some chronic pain patients and others have finding trouble finding a new doctor if there's retires that to make sure that these individuals have access to better pain management as well as treatment. >> thank you doctor stein. >> good morning for the opportunity to discuss and address the opioid crisis for the record our industry's
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primary mention that this effort working with our supply chain partners to regulate our industry and fda and all state regulatory agencies every legitimate entity in the supply chain must be properly licensed and have a valid dea registration look forward to working with committees to address the opioid epidemic and we look forward to your questions. >> good afternoon chairwoman and members of the committee representing the community pharmacist 22000 independents participating in numerous initiatives it includes evaluating prescriptions adopting electronic prescribing taking part
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dispose my meds utilizing the pharmacist toolkit advocating for greater access i will summarize my recommendations i think continue dialogue and continued health care provider resources data sharing including prescriber systems the dea pharmacy may not that been updated since 2010 i would encourage them to do so advancing the role of medication assisted treatment and a medicaid provider to expand the disposal offices. thank you. >> thank you chairman and ranking member and the distinguished members of the committee more of this needs
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to be focused on prevention this is the most cost effective way to deal with the epidemic the program meets the reduction of misuse through the implementation that includes those sectors actively involved supply and demand. we train people to implement strategies to reinforce one another including awareness from changing policy and the procedures to change the physical design of the communit community. for those that have undertaken these types of approaches with those substance use and other metrics that can be
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transferred from the program to build and maintain that capacity and then to break down silos. >> i will yield my time to senator feinstein if you want to ask some questions for the second panel. >> i actually have no questions. thank you for coming. >> i just want to ask a question of the distribution chain i used an example at the outset of 4300 people that received two.7 million opioids. one pharmacy. one pharmacy.
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. . . . we are very pleased wie new functionality that was put forward. >> didn't mr. mcdermott say that it's a matter of months before they get it's a matter of months before they get the information? >> it is. either monthly, he said 30% are monthly. >> your distribution company since thehe massive amount of opioids to a tiny pharmacy in the middle of nowhere in illinois. you believe your responsibilities by contacting? >> we have a responsibility to prevent diversion. that's her obligation under the controlled substance act. >> i would hope that would mean you would contact law
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enforcement to say time out, this is not right. something just happen here. we want to reported. do you feel responsibility to. >> is yes, sir and many of our companies do that. >> the pharmacy itself. you've got to be working at the pharmacy to look at the back door and sayay they delivered what? >> absolutely and our responsibility is not report to arcos but report at the state level. the turnaround time on those berries. some are every four hours. that ishe our members responsibility to report. >> i think we are on a roll call on the floor so we may have to cut it short. thank you very much. >> thank you. i will just wrap up. you talked about alternatives in adequate alternatives for prescription opioids, and the
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barriers that are there for effective treatment for opioid misuse.ha what immediate policy changes do you recommend to increase alternatives to prescription opioid medications? >> i think we need to make sure we're developing, , disseminatig and would financially supporting and paying for alternatives both in short-term and long-term. in the short term we know certain types of pain procedures such as wisdom teeth being removed, we don't need opioids. we need to t make sure we're usg those. or more chronic pain with things like physical therapy. we need to develop and make sure insurance discovering a whole variety of treatments that are effective for people that pain. pain isn't going away. it affects 20% of just adult and if there's one of 12 so much akin to the daily activities. >> i appreciate that very much. your testimony really if you go to the written testimony that
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you have provided, there are some powerful prevention success stories from drug-free communities. how can congress pass support those types of programs? >> thank you so much. just by exerting leadership, and think it's l also important that we have more communities better trained and have the capacity to get those types of outcomes, tiny bits of federal money, $125,000 a year with a dollar for dollar match is basically all that they get. it's amazingly great investment of federal resources. we haveor coons said tiny bump up yesterday, but literally for every million dollars, we end up with another eight to ten rounds. >> very good. i do apologize, folks. we are going to cut you short on your panel today. i think our o other members have all also led to the floor. we've also flee to the floor but
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i do want to thank you for your important input. we do have your written records, and those are submitted for the record. we will make sure of that, and i appreciate the time and attention that you have given to us. thank you sont much. and we'll keep the record open for one week for any members wanting to submit items for the [inaudible conversations] [inaudible conversations] [inaudible conversations]
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[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]
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[inaudible conversations] >> this sunday booktv features three new nonfiction books. at two p.m. eastern harvard university law professor alan dershowitz offers his thoughts on how sexual misconduct accusations should be handled in his book "guilt by accusation." >> i don't want it to go away. i want to disprove it categorically, and so i wrote the book and that all the documents in the back. i have the fbi interviews. i have the narratives she wrote. i have the e-mails she tried to suppress. i have a tape recordings of her lawyers. there's nobody reading this book who come away with any doubt whatsoever that this woman made up this story completely out of
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bold bluff and i never met her. out of her own mouth i never met her. >> at 7:15 p.m. eastern in her latest book the truth will set you free -- "the truth will set you free, but first it will piss you off" gloria steinem chronicles her life and career through through a collection of essays and notable quotes. >> i think it's helpful to see what came before because now the #me too movement, thanks to all of this and thanks to technology and the web, is now all over the world. but it's a process and now it is a majority consciousness. >> and 19 eastern on "after words" university of maryland baltimore county president freeman hrabowski on this book "the empowered university." he's in news by author and anti-poverty firm robin hood ceo westmore. >> we are through our work in the humanities, through the
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sciences, looking at ways of helping students to learn to ask the hard questions, to read critically, but to appreciate the value of evidence in a society that is bombarding us with information and different point of view with things been confused about what is truth td what is not. educated people should have the skills to ask the questions that will lead to the evidence that can therefore determine what is true. >> watch booktv this weekend and every weekend on c-span2. >> the motor speedway was kind of the big event that started this place often terms of worldwide fame. people indianapolis because of racing, and with the healthy
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sport, with a healthy track i don't think that will ever change. >> he was one of the most famous authors to come out of indiana, really up until kurt vonnegut. i've always described as really helping define what a hoosier was. he helped introduce indiana to the rest of the country and indiana loved him for that. >> c-span cities tour is on the road exploring the american story. this weekend we take you to indianapolis with the help of our spectrum cable partners. this saturday at noon eastern on c-span2's booktv local authors, the series history including the speech robert f kennedy made to an indianapolis crowd following the death of martin luther king. >> martin luther king dedicated his life. >> he had no prepared text from his campaign speech writers, and kind of what am i going to say?
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kennedy with someone who could speak to people directly and give them bad news and be counted upon to do the right thing. so it was decided that kennedy would come to 17th and broadway streets to address the crowd that had gathered there. >> sunday at two p.m. in on american history tv on c-span3, we'll visit different historic sites around the town including the home of president benjamin harrison. >> the great since you have as you walk through the spaces out understate it is. it's not ostentatious that if anything it speaks deeply of quality and to think that is his character through and through. understated but of quality. >> watch c-span's cities tour as we take in its history and literary scene.
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>> judges on the fourth circuit court of appeals heard oral argument in two lawsuits filed by the district of columbia and maryland that claim president trump violated the emoluments clause of the constitution which bars presidents from receiving gifts from ford or state governments while in office. next, the oral arguments. .. [inaudible conversations] >> may is please the court.


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