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tv   Politics and Public Policy Today  CSPAN  February 4, 2016 3:30pm-5:31pm EST

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however, in that situation it's often a joint undertaking between us and our partners at i.c.e. and also our partners at customs and boarder protection. a lot of that depending on how it is we encounter the individual. do we encounter them at the port of entry or is it a situation in the interior. >> the person seeking asylum, where are they when you are going through that process? >> where are they, i think your question is are they in the community. that is the -- >> are they in a detention facility? are they released on their own recognizance to a family member or someone in the community while you are doing your vetting? >> depending on the facts and circumstances, it can be any of the above. if they're at a port of entry, that's something that immigration and customs enforcement makes the determination as to whether that individual will be released or not. my understanding is they don't do it if there is any concern in that case about doing it. >> and how long does that vetting process take average?
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i know every case is different. are we talking two weeks? are we talking two months? are we talking a year? >> i would not attempt to give an actual. i think it's incredibly variable depending on the country, the nature of the case, the composition of the family, it can be incredibly variable. i don't think i'd be able to give you any kind of credible time average. i don't know if mr. kubiak has anything he would add to that. >> no, that's correct. it's very specific to the circumstances of the individual, the situation that they've arrived in the united states and then what process they're going to undergo next. >> you all are saying that the level of vetting of asylum seekers is on par with the level of vetting that a refugee goes through. >> that the tools we use are just about the same tools that we use overseas. and, again, in a different setting we can go into detail as to how that's done. >> great. ambassador taylor, it's always a
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pleasure to see you. are you getting enough intelligence on human smuggling organizations or human trafficking kingpins in places like ecuador, brazil, colombia, panama, guatemala and mexico? because those are the networks that are going to be facilitating folks from the countries that are going to try to do us harm to take advantage of our asylum program. >> i am getting significant intelligence through our i.c.e. organization and from the intelligence community. it's not perfect information. but certainly it is an area of very high priority for us. >> on the national intelligence -- on the national intelligence priority framework, do you think the human smuggling is high enough on that list? >> i wouldn't say that it needs to be high enough on that list. it needs to be a high focus for our department. and whether it's on the priorities framework or not, it
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is the bread and butter of what we do. >> amen. >> so, we have focused on that to a great extent. much of the intelligence about migration and that sort of thing comes from our law enforcement partners, from cvp and i.c.e. that goes into the ic. so, it is our responsibility. we are working hard on better understanding that phenomenon and interdicting as appropriate. >> good copy. i yield back, mr. chairman. >> thank you. ms. mcsally from arizona. >> thank you, mr. chairman. and thank you for your testimony and the work that you're doing to try and keep our country safe. i've heard a lot of discussion, i know on some of this you can't answer in this setting, of things that are being discussed or debriefed or best practices, things that are about to be put into place. i realize well intentioned, but there's also a bureaucratic barriers, right, to moving things quickly.
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and i've often said, you know, isis is moving at the speed of broadband, while we are moving at the speed of bureaucracy and, you know, some of those are challenges that you all deal with as you're trying to move things forward. but just to be clear, and you don't have to get into details, have we made changes to the k-1 program since the malik case in san bernardino? like, there are changes now in case? you can tell ums what the changes are classified but we durntly have changed in place based on what we learned from the failures in that case? >> i wouldn't say -- i would say that the case made us look at the process all over again and we identified new opportunities to do better. >> but is there something changed now? >> yeah, no, no. that's one of the things i want to drive at. so, our -- and then i'm going to turn over to assistant secretary bonn, our primary sort of lever in that process was at the time that the individuals seek green cards, so what we are doing, we're going to use it for k
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k-1 but frankly we're going to look at it all across all immigration categories is how we use the interviews that we conduct when we give green cards. >> i don't want to spend a lot of time on it because we talked about it already. what we are doing or going to do versus has something changed today. >> that's something that's different now. we're going to use those more intensively and in a more strategic and targeted way with enhanced lines of questioning to target the kind of issues i know we're worried about. >> thank you. it's off the main topic of the terrorism but, again, also challenges and bureaucracy of the ig report that came out a couple weeks ago about, again, information sharing not happening with human trafficking victims be can trafficked into the country using the legal systems. the ig identified instances where they used the k-1process to bring victims in legally because information sharing between organizations wasn't
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what it needed to be two 274 individuals, i'm reading out of the ig report, subjected to i.c.e. human trafficking investigations who successfully petitioned uscis to bring 4 25 family members and fiances into the united states. they're using the legal system, human traffickers, to bring victims into the united states or family members. we've marked up a bill yesterday to try and close these gaps but has something changed since this ig report in place now to fix these issues? this is a travesty. >> one, we embrace the recommendations that were made in the ig report. long before the report was issued we were doing things to make sure that mr. kubiak's agency, my agency are communicating in order to be able to each other do our jobs best. so, that is -- that is the state of affairs as we speak and i'm sure mr. kubiak can speak to that as well. >> just one more question, again, about known challenges that we've had in the aftermath of the boston bomber is one of
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the individuals arrested from kazakhstan, i'm sure you're familiar with this, didn't have a current i-20 he was on a student visa but he actually left the united states and came back in and he was let in, and the finding was because cvp officers at inspection stations did not have access to i.c.e.'s student exchange visitor information system. so, again, this is information sharing within one organization where the cvp guy's checking him when he came in, didn't have access, that he didn't have a current i-20 on file. has that been fixed? these are all just, like, stovepipe information sharing things, so has that been fixed? >> i'd have to get back to you on that specific incident. >> i'm saying general, daily now, does the cvp have access to the system? >> the systems which are driven primarily by cvp and the biometric exit issue that we talked about yesterday are connected and working together. so, i'd have to get a little more detail specifically on what
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happened in that instance that prevented that, but i'd be happy to get back to you on that. >> please do. it's a broader question of we've just got, you know, bure rock extrassy and stovepipes and information sharing that we've got to know how to speed it up, we've got known cases whether it's the traffickers here or, you know, the one associated with the boston bombing where we've identified where information wasn't being shared. have we fixed that for the long haul and if you need to get back to me, great. i yield back. >> may i just add one thing to the question that you asked about the --s w what's happened a result of the k-1 review because that was very much a joint operation and we were looking at our piece of the k-1. i want to say there have been some actions that have already been taken and already not huge, dramatic, but we spoke to the post that handled the largest numbers of fiance cases. got their sops and reviewed some
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of the standard things that they do working on these cases in high volume and have shared those ideas out broadly to other posts and said adopt these ideas, too, they'll make you more efficient, they'll help you to assure you're not overlooking anything in the process. so, that is an example of something that has already taken place as a result of the review. >> great. >> thank you, the chair now recognizes the gentle woman from texas. excuse me. >> let me thank the chairman and ranking member and to all the witnesses for your presence here today. and i know my colleagues have been extensive in their questioning, and so i will partly be engaging in some of my comments. for those of us who have been consistent and untiring supporters of immigration and immigration reform and the values of this nation, that for
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my early upbringing centered around that magnificent lady in the new york harbor, the statue of liberty. as a child, that's what i grew up on, and i understood this nation to be a refuge and to be a land of opportunity. and certainly living in the skin that i live in, i have seen moments of those of us who live here, experiencing a separate and segregated life and the questions of liberty and justice and opportunity have been a question for americans. so, i understand some of the angst that has been exhibited by americans who may feel that jobs have been lost or security has been jeopardized. and i've always said that the privilege i had of serving not only in this congress but in this committee, which i take very seriously, even more. we are thelines of the
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security of this nation. and it is our job to counter the negative, the angry and the wrong-headedness of some public officials who want to condemn the very entity of which this country has been based. land of immigration and immigrants and a land of laws. you all are the holder of this responsibility, along with the duty of protecting this nation. so, i am going to, having been in judiciary committee and leaving for another committee as we speak, i'm just going to ask all four of you to take the context of what i said, that this is a land of immigrants and the question of recognizing the concern of the security question. start with you, secretary taylor, who were here before, and you were dealing with the
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social media. and so each of you will tell me what you're doing for those two points, securing the nation. you may want to weave in the social media context, how that we are seriously using that as a tool so that we can do right by those who legitimately come to this country, for the values of this nation, and get those -- and i mean get those who come to do us harm. secretary taylor? >> yes, ma'am. i'd be happy to start. first and foremost, the mission of our department and every person in our department is to stop people who want to come to our country to harm her citizens or our way of life. it is how we have organized our screening and vetting. it is how we have built our partnerships with the intelligence community and law enforcement community. and as you mentioned, we understand that our use of social media has not been as
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effective as it needs to be, which is why i'm leading a task force to add that piece of information to our screening and vetting. one of your other colleagues had asked about how we adjust. because the enemy is adjusting as we speak in terms of tactics, techniques, and procedures. it is our everyday focus on how what we're doing mitigates the risks that we're seeing from intelligence and other activity. that's what we do every day. it's our solemn responsibility to this country. the secretary has announced from the day he started on the 23rd of december, 2013, that counterterrorism is the top priority of our department and every official in our department. >> thank you. mr. rodriguez? >> yes. we are -- we have had a number of robust tools in place, and we're fine-tuning and refining
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those tools as we go along to ensure that any of the actually millions of people who we screen each year do not pose a threat to national security, to public safety. we use a series of tools. one of them is the interviews by very highly trained officers, in particular refugee officers. and we're always seeking to refine their train -- not only their training but their preparation for the specific environment that they're addressing. so, if it's a refugee officer that's interviewing syrians, we make sure they are steeped in the country conditions in syria. that alongside all of the technological and intelligence tools that we both use and fine-tune as we continue to do our work. >> mr. kubiak? >> madam, thank you for the question. i outlined what we did -- we're doing overseas with the visa security unit earlier, so i'd like to take a moment to say the
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key thing that we, that i.c.e., brings to dhs and national security strategy is to identify those networks and those criminal organizations that are seeking every day a new way to exploit the security of the nation's borders and working globally to be able to circumvent that security and those protocols that we have to move illicit goods and illicit people and illicit finance both into and out of the united states, whether it's to support terrorist, to finance terrorist networks overseas, to obtain critical technologies or weapons in the united states and export them to other places or whether it's to smuggle people and goods into the united states for nefarious purposes or criminal purposes. and really our role is to identify those networks for the department, to attack those networks. because you can try and stop and defend at the border, but the goal is to push those borders out so that we protect the homeland by being abroad and that we're identifying that entire network and identifying it, disrupting it, and
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dismantling it as we move through and then gaining that intelligence so we continue to harden our defenses. we can't ensure everything. >> secretary bonn? >> yes, in the course of reviewing and assessing each visa application, the consular officers are part of a team really. we often talk about the officer who does the interview, but that person is not working alone. part of what we do is a very careful prescreening review of applications in order to identify questions in the file and focus the time of the interview in the most valuable way. but in every office we also have a unit of specifically for fraud prevention. when an officer has a concern about a case, they can review that case for what you call a deeper dive by the fraud prevention team that will be looking into things. we do use social media in cases where we believe that that -- that that will give us the information we need to resolve questions that we might have.
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and along with our colleagues at dhs also looking at how we can make broader and effective use of social media too. but we really invest in the staff to ensure that they are thoroughly trained to take on the responsibilities that they have in terms of personally interviewing and assessing the qualifications of every single visa applicant that comes to the window. >> thank you, ms. jackson lee. >> thank you, mr. chairman, and ranking member, and i want to say that. and i want us to remain a country of immigrants and laws and keep the values that we were founded on. >> thank you, ms. jackson lee. and the chair recognizes the gentleman from texas. >> thank you for the work that you do every day to support the primary role of the federal government, that being to provide for the common defense
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and to keep america safe from evolving threats. right now the evolving threats from radical islamists jihadists are constantly on the minds of the nearly 700,000 texans that i represent and for good reason. the terrorist attacks in paris and in san bernardino and in other places prove that those extremists intend to exploit, if possible, both the refugee and the visa processes to carry out mass killings against innocent people here in the united states and abroad. so, i know you agree with me. we need to utilize every tool in our arsenal to ensure that the people coming to the united states, whether it's through the refugee program or through -- or on a visa, that they're properly vetted. and in that regard we all fulfill our obligation with respect to the federal government fulfilling its primary role to keep our
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citizens safe. so, let me start and ask you a question, undersecretary taylor, following the san bernardino attack there seemed to be a lot of confusion whether or not under current policy dhs, immigration officials are allowed to review open source social media when considering visa applications. i say that. your predecessor jon cohen was on record saying during that time period immigration officials were not allowed to use or review social media as part of a screening process. following that a spokesperson for dhs came out and said that the department had begun three pilot programs to include social media and vetting. and then following that, the president came out and i think in an effort to clarify said that, and i'll quote, our law enforcement and intelligence professionals are constantly monitoring public posts. and that's part of the visa
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review process. so, help me out. help this committee out here. what is the current policy across the board with respect to dhs, immigration officials authorization to use social as process for visa applicants? >> thank you for the question. congressman. first, let me, as i mentioned first in this hearing, mr. cohen's suggestion that the sect or any department official had prohibited the use of social media by any official in the department as of 2014, it is just not true. we've had a policy in place since 2012. there are 33 instances to date where social media is being used by our components for the purpose of complying with their mission requirements. the one thing that we learned
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after san bernardino and why the secretary asked me to take a review of all of the social media use within our department, was that our efforts were not as robust as they needed to be. and that we needed a comprehensive analogy within the department for the application of social media -- the use of vetting of social media for our mission. and we're involved in that task force today. we've made plans with the secretary in terms of how we plan to proceed and i have a -- a work stream that i had promised to -- to execute that will get us at a better place in terms of where we are. but as of 2014, for any official in the department, for the use of social media. >> so you say it has been part of the policy since 2012. it is being used.
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is it allowed or is it required under that policy. >> under the policy, it is set forth a framework, established by our privacy organization in terms of how components -- >> i'm trying to get at, is it always used? are we using this as part of the process or is it just a tool that -- >> i think that what we've learned is that it is not comprehensibly used. >> and don't you think it should be? >> absolutely. >> and your testimony is that it is going to be. >> for the department to ensure standardized effective social media use across our missions. >> okay. if the chairman will indulge me, i want to follow up with respect to that samish ube as it a --
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issue as it applies to refugees. fbi director testified before this committee and said something to the effect that if someone never makes a ripple in a pond, and in syria, we can vet our data base until the cows come home but it won't help us because nothing will show up. and so i understand that we have a robust vetting system in place when people are in the data base. but secretary johnson and director comey have both testified before the committee that they lack the on the ground intelligence in places like syria to calmly vet individuals. so, director rodriguez, how does u.s., cis, incorporate social media as part of the vetting into the refugee admission program? >> what we are doing right now, and the efforts are focused on syrians, in those cases in which there are flags of -- elements
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of concern in a case, we do a social media review in those cases to further develop and determine whether there is any information in social media which helps us resolve that case. either derogatory information that would lead possibly to a denial or that would satisfy us that the individual was okay. what we're building toward, in very quick order, including with the necessary both training and linguistic capacity to do this kind of review, is to use that across not only all syrians, but also across all iraqis as well. and that -- we will start deploying that capacity as we start hiring and training folks, we'll be doing that in very short order. more importantly, we're going to be looking at using social media across all other immigration categories as well. a lot of that work is done by
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the secretary con seoulalat level. but at adjustment, there may be opportunity to do that at that stage as well. >> my time is expired. but right now you are saying it is allowed only if there is a red flag. >> -- no it is being done. it is in a much broughter category and we are authorized to build it as quickly as we can in a broader category. i would view it as acting and directed but rather than -- >> but allowed but not required. >> not in all cases. because we need to bring that capacity online as fast as we can. >> chairman, i appreciate your indulgence and time and i yield back. >> chair recognizes the ranking member. >> thank you very much. let me thank the witnesses for what i think was excellent testimony before the committee. mr. rodriguez, one thing that i
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think the record would need to reflect is, yes, i.s. is enrolled in the refugee program and a lot of questions about it, but in the process of the questions, i never felt that you got a chance to answer. so can you give us the role that you play in this refugee process? >> sure. and i think the key starting place is that we are one of a multitude of agencies that are involved in it the process. it starts with the u.n. high commission on human rights that first refers the cases to the state department who in turn -- and who at that point it is the first round of security checks are initiated by the state department. both unhcr and the department conduct information gathering in interviewing. we do the actual screening.
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meaning, all of that information that was gathered by unhcr and also by the state department is reviewed by our officers. we conduct an interview based on our knowledge of the country conditions, of the countries where these individuals are coming from. we sift through the results of those back ground checks in order to use that for interviewing purposes. where we do look at social media, we use that as a resource. the burden is on the refugee. that is kind of a critical point, to demonstrate to us, that one, they qualify as a refugee and they are not inadmissible, for example, because they are a terrorist or with a terrorist organization. then the case goes back to the state department that conducts a medical screening and a cultural orientation. the data base checking is going on a continuous basis from the first time the state department initiates the checks, right up until and beyond the time that those individuals are admitted to the united states.
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so if new derogatory information arises about those individuals, that pops. we learn about it. customs and border protection learns about it. state department learns about it. so that we could take appropriate action in those cases. we then see those individuals, again, assuming they are admitting and they have not denied them for some reason, we see them again at the time they apply for adjustment of status. >> thank you. thank you, mr. chairman. >> i think the ranking member. and let me just close by saying that i commend the department in the wake of san bernardino for forming this task force in light of the 2012 policy, i know general tail lor, you have taken criticism, but moving forward it is the right thing to come up with the modern day of social media and make sure that is part of the vetting screening process. and to the rest of the witnesses, i know it is not always a comfortable process and
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it is not always painless, but it is our democracy. and this is the voice of the american people. asking you questions. and i want to thank all of you for your patience and for your testimony here today. the record will be open for ten days. numbers may have -- members may have additional questions and without objection, the committee stand s adjourned. [ meeting adjourned ]
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the road to the white house coverage continues later today with jeb bush at a campaign stop in dairy, new hampshire, where he is joined by his mother barbara bush. new hampshire holds the first in the nation primary next tuesday. you could watch former governor bush live today at 7:00 p.m. eastern on our companion network c-span. if a caucus is the test of a candidate's organization, which is what we saw in iowa, a primary is really a test of the candidate's message. a primary is different because you go in, you cast your ballot and then you leave. a caucus, where you have a spend a couple of hours in a room hearing speeches and then making decisions. and so what we'll see in new hampshire, and what we've seen in the past, is the field really begins to winnow out, especially on the republican side. it is a two-person race for the democrats. and it is a question of expectations. and which candidate is able to meet or exceed those
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expectations. and we see that in new hampshire because, of course, it is the first real test of voters who go to the polls. if you saw our coverage before the iowa caucuses, the one thick we were able -- the one thing we were able to do that no other network could do is take you to the rally or the venues as they try to close the deal about the iowa caucuses. we'll be doing the same thing before the new hampshire primary on tuesday. so as the candidates crisscross the state, whether it is a large event or a campaign rally, our campaign bus will be on the road and give you a sense, a flavor of what is happening in this key state. it is the first in the nation primary. new hampshire as a long and rich history. and for those of you not in new hampshire. a chance to watch it unfold. the director of the national institute on drug abuse says the overprescribing of painkillers must be addressed and is tied to heroin addiction. dr. nora vocal testified before
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experts and the judiciary committee. senator leahy is the ranking member. >> i'll make opening statement leahy and then we'll go to the order that we have established. as you see people sitting at the table there. i'll introduce senators and senator leahy will introduce the governor. america is experience an historic epidemic of drug overdroes deaths. over 47,000 died from overdoses in 2014. that's an all-time high. to put this in perspective, it's more deaths that resulted from either car crashes or gun violence. addiction to opioids primarily prescription painkillers, and heroin, is driving this epidemic. it is destroying lives. families. and the fabric of entire communities. it is something i'm hearing about in iowa. of course other parts of the country have been hit even
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harder. at today's hearing the committee will learn more about this terrible epidemic, what's being done to address it and how congress can help. the committee looks forward to learning more about the comprehensive addiction and recovery act, which is the result of the leaderships x2wh senators whitehouse, portman, klobuchar and ayotte on this important issue. over the last 20 years or so doctors have increasingly prescribed opioids to help their patients manage pain. for many these medicines have been the answer to their prayers. but for others they have led to a nightmare. a nightmare of addiction. the new england journal of medicine estimated over 10 persons reported abusing prescription opioids at some
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point 2014. the emergency room visits involving the misuse of the prescription opioid increased over 150% between 2004 and 2011. treatment admissions linked to them more than quadrupled between 2002, ten years later, 2012. to you -- the use of heroin has also spiked sharply. the national survey on drug use and health reports over 900,000 americans used heroin in 2014, nearly a 35% increase from the previous year. heroin deaths more than tripled between 2010 and '14. in 2007 only 8% of state and local law enforcement officials across the country identified
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heroin as the greatest drug threat. now, this year -- or last year, that number rose to 38% more than any other drug. according to numerous studies, prescription opioids, addiction is a strong risk factor for heroin addiction. in some cases those addicted to painkillers turned to heroin to get a similar high because recently it's become cheaper and more easily available. now, very important question. why has cheap heroin begun flooding into our communities? well, mexican cartels are expanding into new territory because the administration hasn't secured the border. indeed heroin seizures at the border have more than doubled since 2010. the senate caucus on
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international narcotics control joined by our colleague senator ayotte sought accountability for this alarming development at a hearing in november. so this is a complex crisis requiring a multifaceted solution. the first and most important part must be prevention to head off addiction before it can even begin. prevention includes educating the public about the dangers of these substances including through the important work of anti-drug coalitions. it also includes educating doctors, taking a hard look at perverse incentives that may lead to overprescribing. for example, a few weeks ago senator feinstein, ayotte and i wrote to hhs to seek a progress report on a federal review exploring whether patient satisfaction surveys linked to higher medicare payments
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actually encouraged doctors to prescribe opioids. many people who abuse prescription drugs get them from friends or relatives, so prevention always -- also involves support for initiatives that allow patients to safely dispose of older, unused medications. so that brings me back to something i was involved in to help start these takeback programs by working with the senators in 2010 to pass the responsible drug disposal act. i was pleased when d.e.a. acting administrator rosenberg voiced his support for them very recently. at the same time it's concerning that this administration is muddling prevention efforts by sending mixed signals to young people about the danger of addiction to marijuana.
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the president has even accused smoking marijuana as just another bad habit. and the department of justice continues to decline enforcing our federal drug laws in this area. but young people don't need increasing access to another potential pathway to addiction. according to cdc report a person who is addicted to marijuana is three times more likely to be addicted to heroin. another part of the solution needs to include better treatment options for those who become addicted. the use of medication assisted treatment appears to show promise. so along that line overdose deaths may be reduced by the more widespread use of a drug proven highly effective in reversing overdoses. and finally, law enforcement will play a very critical role.
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we can't arrest our way out of this epidemic, but we can continue to crack down on unlawful prescribing practices, enforce our border with mexico and target the violent cartels that are trafficking heroin in this country. so i get back to something else a member of this committee and i have been involved in. senator feinstein and i introduced the transnational drug trafficking act 2015. our bill would make it easier for the department of justice to prosecute cartels who harm our communities from abroad by trafficking heroin, other drugs and precursor chemicals. for ultimate delivery here in the united states. in october our bill passed the senate for the third straight congress by unanimous consent
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but hasn't found success in the house. so it's critical that the representatives finally pass this legislation which will help protect our communities from transnational drug trafficking threats. so i'm finished. i welcome our guests. and i'll introduce them. and now turn to senator leahy. >> well, thank you very much, mr. chairman. i think you look around this committee, republicans and democrats from representing all parts of the country, we know that in our communities whether they're urban or local, doesn't matter what their size, they're grappling with the tragic effects of the epidemic of heroin and prescription opioid abuse. we've all seen the statistics. i'll tell you one thing about the dramatic rise in overdose deaths particularly among young people.
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but go behind the numbers as i have, governor shumlin in our state has, eric miller, our u.s. attorney has, and behind the numbers you see the human impact of this epidemic. families trying to find treatment for a loved one hooked on painkillers. children neglected or left behind by an addicted parent. victims of crime fueled by addiction. law enforcement community officials overwhelmed by the flood of opioids and cheap heroin. my wife is a retired registered nurse. she and i have sat around some of the kitchen tables in vermont. and our some okay are very affluent areas and some are very poor areas. but the stories we have heard from families and parents, and we usually go there just ourselves, no press, nobody
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else, just want to talk to these people. we've had a couple times we've driven away we were both in tears what we've heard. these are human stories. go way beyond the statistics. so it's not a question of whether there is an epidemic. the question is what do we do about it. like many other states we've not been immune to this in vermont. but in probably what we do in vermont, we rally together to tackle the problem head-on through community based and comprehensive strategies. that makes me proud to be a vermonter. we heard testimony about a number of these innovative approaches during a series of field hearings. i convened during the past several years in vermont. in one city in rutland they went to the mayor, a strong republican i might say, and they said do we want to talk about this in our city. said we darn well want to talk about it.
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and we had to keep changing the venue because more and more people wanted to come. we had city officials, their project vision, city officials, law enforcement, residents. and we heard from all of them knowing that this is not just law enforcement, it's not just a medical profession. we had the faith community, parents, educators. they're all in it together. the boys and girls clubs throughout vermont are working with schools and public health officials to help children swept up by this. in all of my conversations though with vermonters from law enforcement down through one thing is clear, we cannot arrest or jail our way out of this problem. we've lost the war on drugs because we relied primarily on a necessarily harsh sentencing laws. we can't repeat these mistakes of the past. we've also got to start working on the demand.
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we can close everything -- let's assume we can close everything coming from mexico. if we have demand in this country, it will come from somewhere else. so long as we have people who spend the money who want to buy the opioids, who want to buy the heroin, it will come here. i don't care which border we close. it will come here. we've got to stop the demand. we have to identify and support effective prevention treatment recovery programs. and we can't just pay lip service to our communities. after the field hearing i convened in rutland i advocated for a new federal grant program for expanded treatment options for heroin and opioid abuse. i work to get more federal funding for law enforcement to go after drug traffickers. in vermont we've seen a 65% increase in the number of vermonters getting treatment for their addiction in the last couple years. and, governor, i thank you for that. it's great progress.
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but we know on any given day there are hundreds more find themselves on waiting lists. the patients in rural corners of my state travel hours just to get their medication. so seeing senator shaheen, i co-sponsored her bill to fund additional public outreach and treatment in recovery and law enforcement efforts. proud to co-sponsor the comprehensive addiction and recovery act. hope the committee will report that bill soon. we can talk about it. we can have bills. we can have resolutions. let's spend the money. spend the money for things outside our country, let's spend the money for things in our country. this is a great danger and we should spend money on it. so i will close by thanking governor shumlin. he's been a national, local leader on this issue.
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the governor gave in his state of the state address in the past, instead of saying everything's going great, we've got all this, as most governors do, he talked about this problem. that was his whole issue. boy, the reaction around our state and around the country saying it is about time, it is about time somebody speaks up. so senator grassley, i thank you for convening this hearing but we've got to find comprehensive and enduring solutions. federal government will do its part to provide resources and support that's necessary. that's important. but we have to act. we're not going to rest our way out of this. everybody in law enforcement knows that. we're not going to do it by simply saying let's course a source from one country because it will come from another country. we've got to attack and work and do all the comprehensive programs in the faith community, the educators, law enforcement,
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parents, medical facilities, to stop the demand. until you stop the demand. we'll always have the problem. thank you. >> why don't you continue your introduction of the governor, if there's anything else you want to say at this point. >> well, thank you. go ahead. >> obviously when you're introducing colleagues like i'm doing, there's -- you know an awful lot about them that ought to be said. but you have to kind of keep -- >> can't do that. >> but i can say all of them are extremely dedicated to fighting the opioid epidemic sweeping their communities, and i'm grateful that they're all interested in this and that they have been button-holding me for a long time to move along with this hearing. and i think from initial discussions with members of this college, we feel both from a
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cost and substance standpoint we can move ahead. i hope that's the outcome. after i talk to all of my members. first witness, senator ayotte, new hampshire. she is co-author and original co-sponsor of this bill, s524, the comprehensive addiction recovery act. she is a former prosecutor and attorney general, was one of the leading voices in congress seeking solutions to opioid epidemic. our second witness, senator shaheen, also from new hampshire. she is also co-sponsor of the measure and have been highly effective on the issue. new hampshire is fortunate to have two senators working across the aisle on this very important crisis issue. next, senator rob portman from ohio, co-author and lead republican sponsor of cara.
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he's worked tirelessly bringing awareness to this epidemic drought the state, involved in the drug-free community act and also probably 20 years ago came to my state to help me with a non-profit organization that i started in my state as well so our relationship on this issue goes back a long, long time. and now it is your opportunity on the governor. >> peter shumlin is a small business owner and public servant, father of two, two wonderful young women. he's a committeed entrepreneur, a long-time co-director, along with his brother with a national geographic student expeditions. your brother told me he's -- at the opening of the session, he's counting the days to get you
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back there in the company. it is a company that sends students on educational programs and student project across the globe. partnering in several real estate companies that provide housing and commercial space in southeast vermont. i've known him forever, seems his career spans 30 years ago when at the age of 24 he was elected to serve on the town select board. in 1990, he was appointed to fill an empty seat in the vermont house of representatives. he served there three years. he then served for eight years in the vermont senate where he was elected by his colleagues, republicans and democrats alike, to lead the senate as president pro tem. he's the 81st governor of vermont and and is a very close personal friend. >> thank you all very much and we'll do it in the order that i introduce you so senator ayotte, senator shaheen, senator portman, then the governor. proceed, please. >> thank you, chairman grassley,
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ranking member leahy, members of this committee. i am so pleased that you're having this hearing today because this is the most urgent public health and safety crisis facing my home state of new hampshire. having served as the attorney general of our state, i can assure you, i have never seen anything like this in terms of the epidemic that we are facing. so the timing of this hearing could not be more important. i'm very honored to be here with my colleagues, senator shaheen. in the fall we held a hearing, a field hearing, of the homeland security committee and heard from people in new hampshire, but we also heard from the director of the office of national drug policy who's been a very strong partner with new hampshire. so i appreciate the work that senator shaheen and i have done together on this issue for our state. i'm very honored to be here with governor shumlin who's had such a keen focus on this issue.
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finally, i want to thank my colleague senator portman who's been a leader on the comprehensive addiction and recovery act. he has a long history with this. because he started his own anti-drug coalition in ohio. he's also led the effort when he was in the house of representatives to pass the drug-free communities act which spawned coalitions across this country. now working with senators klobuchar and whitehouse, i was proud in september of to 14 to introduce the comprehensive addiction and recovery act. i want to thank the members of this committee who are sponsoring this act. senators hatch and blumenthal and i want to thank senator donnelly for the work we've done together on this important issue. today you will hear in the third panel from the police chief, nick willard, of our largest city, manchester, new hampshire. he is going to talk to you about the epidemic facing our state,
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how we can address this together, both law enforcement, working with those in prevention, treatment and recovery, and i had the privilege of doing a ride-along with the manchester police department. and i also did one with the manchester fire department. i was there an hour and a half. we went to two heroin overdoses within an hour and a half. and i can assure you, this is hitting every family in some way in new hampshire. i watched our first responders bring people back to life with narcan. but for them being there and having this life saving drug, they would have died. it just really struck me how devastating this is. because one of the cases i went to, there was a baby in the crib in a corner. so when we think about there, this is not just the impact of those who are struggling with addiction, it is the impact on all of our quality of lives and of course on the future for our children.
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in new hampshire, in 2014, we had 320 drug overdose deaths. that was a 60% increase from the year before. this year our chief medical examiner tells us that 385 -- 148 of those deaths are also attributed to a devastating drug called fentanyl which dea tells us is 50 times more powerful than heroin. and that is an issue i believe needs to be addressed by this committee as well. solving this crisis requires a wholistic approach. comprehensive addiction and recovery act that so many members and i really appreciate the leadership on this committee on this act -- is critical, i believe. we brought together over 1 20 stakeholder groups around the country to put this legislation together. those who were on the front line in every aspect. it has the endorsement of the national district attorneys
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association, the major county sheriff's association, the community anti-drug coalitions of america, and the national associations of attorneys general. i would note by the way, my attorney general from new hampshire has endorsed it, the iowa attorney general has endorsed it, the vermont attorney general has endorsed it and many others of your attorneys general have said please pass this legislation. it focuses on a holistic approach. expanding opioid prevention and abuse it is -- abuse efforts. we have to get into the schools and get prevention focused on opioids, prescription drugs and also heroin. expands the availability of narcan to first responders and law enforcement. support to additional resources to identify and treat incarcerated individuals so that so we can end the revolving door that we see in our prisons.
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expands drug take-back efforts to promote the safe disposal of unused or unwanted prescriptions. strengthens prescription monitoring drug programs. and launches prescription opioid and heroin treatment intervention programs. we can administer narcan and our first responders are doingen a -- doing an amazing job of bringing people back to life. but if we don't get the support and treatment for those who are struggling with addiction and deal with the underlying issues, we are not going to solve this problem. as the chairman -- and you will hear from chief willard today -- we cannot arrest our way out of this problem. this is not just about statistics. this is about real people dying, real people like courtney griffin, from new hampshire, who was 20 years old and had such a promising life before her. real people like the grandmother who told me the other day, as she waited on me in the store, i lost my granddaughter. we can make a difference in the senate and in this committee by passing the comprehensive addiction and recovery act, by working together to not only
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support our first responders, but to make sure that we're focusing on prevention. make sure that those who are struggling addiction, that we get them support and treatment for recovery. most of all, we can turn this around. because i've also heard the redeeming stories, people like eric spauford who was addicted to heroin and now has established treatment facilities in new hampshire and is turning this around. but we need to act immediately. this is a crisis. i'm so glad that you're holding this hearing today. i thank all of my colleagues who are working on this issue, and i thank this committee for its leadership and i look forward to working with you. thank you. >> thank you, senator ayotte. >> thank you, chairman grassley. ranking member leahy and members of this committee for giving me the opportunity to testify this morning. i am a co-sponsor of the comprehensive addiction and recovery act and i appreciate the leadership of my colleague,
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senator ayotte and white house and klobuchar and all of you who are working on the committee who are working on this legislation. i'm actually here to testify, however, not on that bill, but on two bills that i've introduced. the opioid and heroin epidemic emergency supplemental appropriations act. that is a mouthful. but the bill would allocate $600 million in emergency funding to address this national crisis. the second bill is the combat heroin epidemic and backlog act which would authorize a grant program to help reduce the chronic backlog of heroin and fentanyl cases at state police crime labs. and mr. chairman, you and senator leahy and my colleague, senator ayotte, talked eloquently about the statistics that affect this epidemic. but the fact is, i believe what we have now is a pandemic. it is affecting young and old, it is affecting urban and ruralx
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rich and poor, white and minorities, and it is spreading to every state in this country, including alaska and hawaii. in new hampshire we're losing more than a person a day to drug overdoses. last year, three times as many people lost to drug overdoses as traffic accidents. and we just had a study come out on mortality rates in this country that show that mortality rates among middle-aged white americans are actually increasing for the first time in decades, rather than decreasing. and that was attributed primarily to the rising substance abuse disorders. so as senator leahy said, those statistics don't adequately describe the devastation to families who have lost loved ones and who are still struggling with trying to get but despite all these statistics, despite the stories
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that senator ayotte and i have heard in new hampshire, and that all of you have heard in your home states, public health and law enforcement agencies at all levels lack the resources to mount an effective response to the heroin and opioid epidemic. and nationwide, in 2013, nearly 9 out of 10 people who needed drug treatment did not receive it. this is tragic, and it is unacceptable. and we need to mobilize a national response. my legislation proposes $600 million. specifically it provides an additional $200 million under the edward burr momential justice assistant grand fund to aid state and local effort in prosecutions been law enforcement and court programs, drug enforcement, treatment programs, as well as education and prevention. lest you think $600 million is too much, remember that last year congress passed $5.4
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billion in emergency funding to combat the ebola outbreak. and we lost only one person in the united states to ebola. in 2009, congress passed nearly 2 billion in emergency funding just to fight a swine flu epidemic. so we need better coordination and better resources. i think you will hear from chief willard the challenges they have in new hampshire because they don't have resources they need. i also want to touch briefly on the combat heroin emdemmic and backlog act which is designed to help drug labs -- crime labs across this country as they analyze drugs. this bill is modeled on what we did in 2005 to combat methamphetamines. what we are seeing in new hampshire and across this country is that state police forensic laboratories have accumulated a backlogs of heroin
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and fentanyl cases because they don't have resources to do the testing. in new hampshire, the state forensic lab receives about 750 testing requests each month, but it can only process 450. and the growing backlogs result from an increase in heroin cases and a dramatic surge in fentanyl cases. just to give you some idea of senator ayotte touched on this, but in new hampshire, according to our chief medical examiner, in 2013, we had 193 overdose deaths. 18 of those were fentanyl related. in 2014, we had 326 overdose deaths. 145 of those were fentanyl related. and in 2015, we had 385 deaths from overdoses, 253 were fentanyl related. we have got to act with a sense
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of urgency because delays in processing drug samples have disrupted every stage of the policing and judicial processes. we are no longer able to identify combination and designer drugs by sight. undercover law enforcement are forced to wait to verify samples before continuing investigations. and prosecutors and judges are less likely to offer plea deals without lab confirmation of a drug's authenticity. put simply, these backlogs are keeping us from putting dangerous criminals an drug traffickers back in jail and off the streets. so, mr. chairman, there's obviously a lot of work that we need to do to address this pandemic. i believe it is something that working together we could overcome but it will take a multi-faceted approach, together, and you've got to act now before things get even worse. >> thank you, senator shaheen. senator portman.
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>> thank you for having the hearing today and letting us come before you to talk about a critical issue we face in every single one of our states. in practically every community in this community. that's this epidemic of heroin and opiate abuse. senator ayotte talked about the s 524, which is the comprehensive addiction and recovery act, cara, a bipartisan bill that addresses this issue head-on in a comprehensive way, through prevention, through treatment, through recovery. it is one i've had the privilege to work on with my colleague and co-author sheldon whitehouse who's on this committee, along with senators ayotte and klobuchar. we've been working on this for a few years now. we've brought in experts from all around the country to give their best advice. this committee's done some good work already. i was very encouraged, mr. chairman, by your comments
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earlier an by the ranking member's comments about the importance of addressing this issue in a comprehensive way and about the importance in moving this legislation forward and again, i thank you for that. i think it is the appropriate federal response to this growing epidemic. i also want to thank those experts out in the field from every area, prevention, all the way through recovery, who have worked with us over the past years in putting this together and participated in about a half dozen forums we've had here in washington, d.c. where they've given us their input. we've all been back home, too, getting input. no matter where i go in my home state of ohio, i hear the same story. i hear it from mothers, i hear it from fathers, sisters, brothers, friends. i hear heartbreaking stories of how addiction is ruining lives. tearing apart families. devastating communities. this epidemic is striking very close to home. i know you're hearing that, too, as you go home. last year, 2,482 ohioans died
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from a drug overdose. that should demonstrate to all of us how difficult it is to break through this addiction, the bonds of addiction are so strong. recently i was in a hospital last week in cleveland, ohio looking at the amazing care they are giving to addicted babies. i had a chance to talk to some mothers who continue to use during their pregnancy. that's how strong these bonds of addiction are. thousands more, of course, are surviving these overdoses, but they are still struggling to hold a job, they're struggling to take care of their families. economists tell us that addiction now costs this country $700 billion every year. that's lost productivity, more expensive health care, it is what's happening to our emergency rooms in all of our states. it is more crimes. it is the cost of incarceration, it is the cost of policing. that's a lot of money. but of course it doesn't tell
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the true cost in human lives. you all talked about that this morning. it is the cost in dreams that are never fulfilled. i think this hearing will be very effective in helping bring awareness to the severity of the problem. we've heard it already this morning. but i think it is just as important that we talk this morning about the reasons for hope, that there are alternatives out there, there are ways to address this and ways to combat this epidemic and lives can be saved. no one knows this better than senator grassley and senator leahy because they've been at this for a couple of decades. as was mentioned. i worked with them back on prevention strategies that actually worked. and we had spawned more than 2,000 community coalitions together with the drug-free communities act. but now we need to do more, we need to focus more on not just prevention and education but dealing with treatment and recovery. i've seen some amazing people who lead programs in my state that actually work. i visited with a lot of men and women who struggle with addiction and have the courage to seek treatment and get on the
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road to recovery. i've also been fortunate in you -- enough to have to get to know a lot of ohioans who have taken their personal tragedies, channeled their grief and used their story to help others avoid addiction or break the stigma of addiction. you'll hear from one of those women here this morning. tonda da re, i first met last fall. she came here for the rally on the mall against addiction and she told her story to me. her story is one that breaks your heart. her daughter, holly, was 21 years old when she died of a heroin overdose. now to the outside world, holly didn't fit the stereotype of someone who was a heroin addict. she excelled in school. she had a lot of friends. she was selected for homecoming and prom court.
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she was building a life for herself. she was engaged to be married. and then on her 20th birthday, at a celebration, some friends of hers said, why don't you try this? and they gave her some heroin. she thought she would experiment with it. and she got into the grips of addiction. tond did, as you'll hear later, i suppose, what any mom would do. she helped her daughter try to get into treatment. holly went to rehab. she actually gained a period of sobriety. but then the addiction took over. she overdosed. and she died. tonda, again, has taken that tragedy and used it in a constructive way to help others. her group is called holly's song of hope. she now has 40 chapters around ohio and around the country. it is in the hopes that other daughters will not follow that similar dangerous path. i commend her.
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there are so many others who have done the same thing i've met in the state of ohio. last week i visited marion, ohio and i met bethany who has struggled with heroin addiction. she struggled as a teenager. she was a promising athlete. she was going to college. she had a scholarship. but she got sidetracked through her addiction. she was an expecting mom and she used. and she says that tearfully now. she was arrested. law enforcement tried to deal with her issue by not putting her in jail by finding alternatives. she finally figured out she had beat her opiate addiction because of her kids. and she did it. detox was hard, recovery even harder. but she went on to graduate from marion's treatment court and alternative sentencing program where they provide resources for mothers facing substance abuse. after five years of being sober, bethany now leads that
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specialized docket as the court coordinator to help other mothers in recovery. to my colleagues this morning, the story of bethany tells us why there is hope in the face of this addiction. you've seen it in your states. we've seen it around the country. people can break this grip of addiction and get into treatment and recovery. it is hard. they need our help. listening and learning from these families is what helped us inform our work on c.a.r.a., every step of the way. as sheldon white house will tell you. this legislation is comprehensive, and will help these communities with all these proven strategies. i am committed to passing this bill and getting it signed into law because i truly believe it will make a difference in the lives of the people i represent. and until the families you represent. i once again want to thank the nine members of this committee who have co-sponsored this
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legislation. i want to thank those who are willing to work on getting this reported out and on to the floor for a vote. and again, i'm encouraged at what i've heard this morning. i think c.a.r.a. is an investment. it is an investment. it is not inexpensive. but it is an investment at a time when communities are desperate for resources and expertise to best practices that come through this legislation. it is a small investment for the future. we will know success by the number of empty jail cells and the number of people who never have to struggle with addition in the first place, the moms and dads who can be reunited with their kids. the message is very simple today, there is something we can do to help. from those who struggle, you are not alone. we are with you. there is hope. and that hope can be furthered by this committee leading the way by reporting out this legislation. thank you, mr. chairman. >> thank you, senator portman.
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now governor schumlin? go ahead. >> thank you, mr. chair. it is a real ln nor to be here to share some of vermont story with you. i got to thank my great friend, senator leahy, for inviting me down and giving me this privilege. i'm glad to have my u.s. attorney here with me, eric miller. and maybe before i add to your colleague's extraordinary comments on this crisis, i just have to tell you this. when governors give the state of the state or the inaugural addresses, it is kind of a big deal for us. we spend a lot of time on. it and we lay out proposals that we think make a difference. i made the mistake this year of doing that and half way through the speech acknowledging two of my favorite people on this earth, senator leahy and his wonderful wife marcel. they got the longest, biggest standing ovation of the speech. needless to say, the press wrote
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senator leahy and marcel get biggest standing ovation of the speech. that was all that was heard about my state of the state. so i won't make that mistake again. listen, i was going to share with you many of the stories -- heartbreaking stories that you've just heard from your extraordinary colleagues from new hampshire and ohio, so i won't. vermont has the same heartbreaking stories. when i dedicated my state of the state address to this subject, needless to say, it was a pretty lonely place for vermont to be. there was a long debate about whether vermont really had that big a problem, and should the governor really be spending this much time on this one. so i got to tell you, it gives me a lot of hope to hear from your colleagues, as well as to see this committee focusing so intently on this challenge that we're all facing together. i came in to this knowing very little about addiction. but i was just listening to
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vermonters, much like senator leahy has as he travels around the state and the heartbreaking stories. i started asking how did we get into this mess, and what do we do to get out of it. when i started talking to the addicts, to law enforcement, to docs, nurses, prevention folks, i learned that we were doing almost everything wrong. almost everything wrong. why? first, our criminal justice system was designed to do -- to maximize addicts going to prison and not going to treatment. just plain and simple. i learned that the most likely chance you have to move someone from denial -- and denial with this addiction is extraordinary. it makes denial for alcoholism or the other addictions that we all face with our family an friends look small. but the most likely chance you're going to get to get an opiate addict to agree that they've got a problem and go to treatment is that moment when
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the blue lights are flashing, the handcuffs are on and they've bottomed out. what i found was that in vermont, we were missing that opportunity every single time. it took four or five months between getting charged and going before the judge to wind your way through a court system. by then you were back using, back abusing, you were back addicted, you were back doing crime in the streets to feed their habit. so we moved to a rapid intervention system where i literally fund for every state's attorney in our state -- the state funds an assessor, third party assessor, who every time there is a bust goes in and makes the determination, is this person someone we should be scared of, in which case they go through the old system, and end up most likely in jail, or is this someone that we should have hope for, get into treatment, and move back to a productive life. all i can tell you is it is working. we are finding the vast majority
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of folks who are suffering from this disease won't hurt you, they'll just hurt themselves. we're moving them to treatment, to recovery, to a comprehensive hub and spoke system. not that there aren't failures, not that they don't have set-backs, but that actually moves them into recovery. it has reduced our incarceration population dramatically. vermont saved $50 million in the last several years not locking folks up, but instead getting them into the treatment programs and back into a productive life. and it is working as well as one might hope. second, we've expanded treatment like mad. and even with tough budget times, we've made tough choices, but we're building out our treatment centers as fast as we can. that, too, is having a huge effect. our problem is that as we have removed the stigma, as you are helping to do right here in this hearing today, mr. chair, we have more and more folks willing
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to come forward and say i've got the disease, i need help. as we build out the treatment center, and i now new hampshire is finding the same challenge, we literally are finding longer and longer waiting lines because there's more demand. but we have to keep building out treatment centers and we need help in building out those treatment centers. third, the rescue kits that your colleagues mentioned about the narcan is absolutely critical. we were the first state to get into state police and law enforcement hands, into the hands of firefighters. everyone will take it. we've saved hundreds and hundreds of lives. this is expensive stuff. we need help saving lives. prescription drug monitoring program that senator shaheen has mentioned that she wants to build upon is critical. we've had governors from all over new england working together to improve the data where folks are shopping for prescription drugs across state lines. so without telling you more
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about what i think we're doing right and what's giving me hope, i want to mention a little bit about what isn't giving me so much hope. listen, we need financial help. the states cannot do this alone. as an example, when senator leahy helped to get us a grant for $3 million, it seems like a small amount of money in washington but it was huge for vermont in allowing us to get it to the howard center, to the clinics, to actually help us build out our treatment centers. we're scraping together pennies to try and make our treatment centers stand on their own. so financial help from washington is critical. i am encouraged by the bipartisan support here in the senate to help us get the financial resources that every state needs to fight this battle and to win it. so money, huge. second, we've got to look at what's holding us back in treatment. one of the things i got to tell
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you that i found in vermont is that as we build out our treatment centers, particularly this is true in small rural states, where we're having challenges getting enough primary care docs in the medical field to deal with the illnessel field to deal with the illnesess that we're all facing with the medicaid and medicare underpayment to them and so forth, we do not have an extra physician force to deal with the magnitude of treatment that is necessary to successfully win this crisis. to get treatment to folks that need it. so, you got to ask this question, and this is a federal change that i beg you to make -- why is it that physicians assistants and nurse practitioners can prescribe oxycontin and other drugs that lead to heroin addiction but they can't prescribe the treatment drugs that would allow someone to get off this stuff and back to normal life? why is that? so, i ask you to help us in expanding the force on the
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ground that will help us actually be able to treat folks by making it immediately possible for physician assistants and nurse practitioners under the direction of physicians to be able to prescribe the maintenance drugs that allow us to move from addiction. and i just want to close by saying this -- we do need to ask this question. why are we in this mess? what led us into this mess? why are all 50 states on a bipartisan basis saying we need help? this is everybody that's having this problem. this disease knows no racial boundaries. it knows no income boundaries. it knows no partisan boundaries. everybody's in. and i think we have to have a more honest discussion about what led us into this mess. listen, i know that our instinct is to say, wow, those folks down
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in south america and other places are sending us lots of heroin and it's a huge problem. well, of course, it is. but i ask you, is that a new problem? has something changed dramatically in the last decade or so that has brought this heroin to america? and i would say no. we've always had this problem of drug dealers trying to get support their countries and their wars and everything else by sending illegal drugs to america. so, then, what did change? and i think it's important for us to have an honest conversation about this. what changed was that we changed our attitudes in america and our practices in america in the late 1990s about how we deal with pain. why aren't we talking about that? listen, this i can tell you, i have a lot of hope for where we're headed. i'm incredibly discouraged that we still have more people signing up for opiate addiction
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in vermont than we had when we launched this battle two years ago. well, why? listen, the facts matter. when the fda approved oxycontin purdue several years later, the manufacturer of that drug, pleaded guilty to telling physicians and docs that this painkiller wasn't addictive. they paid a $60 million or $70 million fine in the same year that $11 billion worth of oxycontin and other painkillers were sold in america. listen, these facts matter. in 2010 we prescribed enough oxycontin in this country to keep every adult in america high for a month. we did. those are just facts. in 2012, we prescribed 250 million prescriptions of oxycontin. now, there's only, last time i checked, roughly 250 million
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people in our country, so that's a prescription for every living american. just a few years ago the fda approved zohidro, i call it oxycontin on steroids. we're about to do this all over again, team. and guess what, when they approved that, they didn't make it tamper resistant, so you can snort it and shoot it. that's what led us into this mess. listen, just this year they approved oxycontin for kids. i mean, you cannot make this stuff up. so, i ask us to pause, to take a deep breath, and to ask this question -- are we willing to have an honest conversation about the way we're dealing with pain medication in america? because i can tell you that until we do, all of the good work that we're trying to do together will lead to more tragedy, more loss of life, more
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of our sons and daughters dying of opiate addiction because that is what has changed. what has changed is that we simply pass out painkillers like candy in america, and we're unwilling to have that conversation. thank you. >> senator leahy? >> mr. chairman, i assume our senate colleagues probably have to leave. i've seen the senate schedule. it's not the house schedule, but the senate schedule is pretty busy. i'd ask that they -- the senators be excused. but i do have a question for the governor. >> yeah, if you want to go, go. i don't have questions for you. we can talk anytime, and i look forward to continued conversation on this legislation with my colleagues. so, you can stay if you want to. go ahead, ask governor your question. >> thank you, mr. chairman.
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governor, you and i have talked about this a lot, and i appreciate your passion. i would note for everybody here, this is not just something that the governor says publicly, he's talked about a lot privately. and i think -- i think it's fair to say you feel as -- the same way that i've heard from police officers all over the state of vermont. it's not just the law enforcement problem. i think a lot of them certainly tell me both that the federal level police, the state police, local police, county, they tell me that they could get people into treatment, they would much prefer doing that. is that the same thing you're hearing? >> absolutely. and i've got to say that law enforcement has been extraordinary ally in this battle. and i know this is true not only in vermont but across the country. i was recently on a panel with a
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police chief in gloucester, massachusetts, who literally said, listen, here's my policy. and now new hampshire and vermont law enforcement folks are doing exactly the same thing. if you're addicted to opiates, come to my station. we won't arrest you. we'll get you into treatment. we'll get you into recovery. we're not arresting any more folks who are addicted to this disease and are nonviolent. and, you know, i sometimes think we don't give law enforcement enough credit for being on the front lines of this. for years we said to law enforcement as a nation, this is your problem, go settle it. and, you know, if i were law enforcement i'd be a little raw about that. but instead they've said, hey, we want to partner with the medical community. we want to partner with treatment folks. we want to partner with families to try and solve this problem as a disease, not a crime. and, you know, without them, we would not be where we are. >> but we also have to have a place where they can bring these people.
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have a diversion program. >> yes. >> i think we'd all agree you got to then have the people -- >> absolutely. >> -- there. >> absolutely. and we're literally scraping together the resources to try and pull this off. i cannot tell you that vermont probably i bet you anything the senators from new hampshire would say the same thing. >> senator grassley is mentioning to me nurse practitioners. >> i think we ought to follow-up. we have a lot of -- you know, nurses -- the attitude towards nurses in america is you can't do your nurse unless you got a doctor looking over you. we got to change that. and i think your suggestion. but in rural america we're going to have to make greater use of nurse practitioners. >> i'm somewhat partial to nurses, as you know. i have a daughter-in-law who is an active nurse practitioner. >> i guess in the order of durbin and then whitehouse and then klobuchar. >> i want to thank my colleagues
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for coming. no town too small, no suburb too wealthy not to have heroin overdose deaths in the state of illinois. i want to especially thank governor shumlin, because i think you pointed to something we need to point to. we can all endorse the legislation that's been prescribed. every single piece of it, i look at it and think, i'm for that. you go to the heart of our responsibility. the food and drug administration, the pharma industry, the dirty docs. you know, we don't have to go to the border here to see the source of opioids, you go to the pain clinic in the mall, you know, you go to the doctor just around the corner, you go to the pharmacist who looks the other way. and clearly i think we have responsibility here. pharma is making a fortune off this. now, i'll concede the fact that over the last ten years we have decided to tackle pain directly. and i'm glad. for a lot of people it's the difference in quality of life
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that we have to readily acknowledge. but with it has come a dramatic abuse. to think that the prescriptions, legally written prescriptions in this country, result in a bottle of pills for every single adult american. as you said, to treat them with this drug for at least a month tells me it's out of control. congress, what are you doing about this? senate, what are you doi ing abt this? and the fda dreaming up new applications for children and for super opioids? where in the heck is the congress in terms of our responsibility when it comes to this? and the second point i'd like to make is that police chief in gloucester ought to be here today, because dixon, illinois, population 20,000 went to visit with him and decided after four heroin overdose deaths in one weekend, they were going to buy
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into his program. 25 kids came forward. young people came forward. do you know what happened? they went into treatment. >> yep. >> do you know what happened to the jail? it was empty. the petty crimes. the burglaries, the thefts to sustain these habits started disappearing. but there's a key element here. how did they get into treatment? if they're lucky enough, if they're lucky enough, to have health insurance and their families, they have access. if they're lucky enough through the affordable care act to have access to medicaid, then they get into treatment. and we all know, we don't have enough resources here to treat these people. we absolutely positively have to do it. i want to commend, too, we have our senators from minnesota here, it was senator wellstone and senator domenici in a bipartisan effort that demanded and finally after years succeeded in bringing reform to health insurance so that it now covers mental health counseling, it now covers addiction care
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services. those who want to repeal the affordable care act, put your hand up if you want to repeal that part of it. it would be disastrous in america as we consider the drug overdose and those kind of things. thank you for really turning the spotlight back on us. it's not just all the things we've heard. we've got to look at fda, pharma, we've got to look at what's going on with the illicit prescription and filling of prescriptions across america. that is our responsibility. thank you. >> we'll go back and forth, so i'll call on cornyn and then whitehouse. >> i want to take a second to thank our colleagues for your powerful presentation here today. and i think what we're seeing in america is we're reconsidering a lot of our criminal justice policies. and this committee, under the leadership of chairman grassley, has passed out, for example, a criminal justice reform bill something that senator portman and others have worked on a lot. i hope we -- as we look at this
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terrible pandemic as senator shaheen called it, we look at this comprehensively. because i don't know if you can draw any artificial lines between dealing with mental health issues and the criminal justice system and drug addiction issues. because we know from talking to our sheriffs that many of our jails are populated by people with mental health issues for which they self-medicate if they are unable to find other places where they can get some help. but i would also like to make a plea of my colleagues on behalf of somebody who represents a state with 1,200 miles of common border with mexico. demand is a big problem, governor. i thank you for your powerful testimony. but we also need to deal with the supply issue as well. and i know it's tough. our friends in mexico say, well, we wouldn't have all the drug cartel activity and all the transportation of drugs into the
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united states if there wasn't such demand in the united states. so, we do have to deal with both of those. but i hope as we look at this we won't draw any artificial lines or create any stovepipes and we will try to find a way to deal with this in a broader, more deliberate sort of way. thank you. >> senator whitehouse? >> mr. chairman, i'll put my statement on the record so we don't go on too great length. we have two panels ahead of us still. but while senators portman and ayotte are here, i wanted to thank them for the terrific work they did as original co-authors of this bill. senator klobuchar and i are very grateful. so, i thank them. but i also want to particularly thank senator hatch and senator graham, who were the first two committee sponsors on the majority side for this bill, and they've helped make sure that we have this hearing today. and i want to just make a record of how important senator hatch
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and senator graham have been to getting us to this point in addition, of course, to the chairman himself, who made the call. so, thank you very much, and whatever else i'll add to the record. >> okay. senator tillis and then senator klobuchar. >> thank you, mr. chair. i'll be brief. to my colleagues, thank you for being here and thank you for your work on this. and, senator ayotte, a special thanks to you for wearing carolina blue and black after your patriots got eliminated. governor, i -- [ inaudible ] well, i think it's a great step. >> it is. >> and look forward to seeing it move through the process. governor, i had a question for you. i am a personal friend of your speaker. i've known him for about five years having been speaken down in north carolina. to the point that senator cornyn is making, and i do agree to a large extent with what senator durbin said.
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but if we focus on, for example, the prescribed painkiller problem, then, i think we're going to see an increased uptick in heroin abuse. i mean, it's obvious it's happened in north carolina. it's a matter of state policy. we did a number of things to crack down on drug shopping and the sort of things we're seeing in the state and there's almost a direction correlation between the reduction in the prescribed opioids and the increase in heroin use. as a matter of state policy, what are you all looking at? i'm also very struck by the fact that some states are at great disparities between overdoses and deaths. i was shocked to know that ours had gone up 480% over 3 years but it's still a fraction of what a state that's got 1 1/2 million people have versus a state that has 10 million people. so, you know, what are we doing to address these specific
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issues, and what risks do we run of federal policy potentially hampering what you think and your speaker and your senate leader need to do to address the things that are unique to some of these states that seem to have disproportionate problems? >> yeah, you know, that's a great question, senator. and i can't tell you why some states are being hit harder than others. but this i'm convinced of -- i don't think that we would have the heroin problem in america if we weren't starting folks out on opiates that are sold over the drug counter stores. it isn't coincidence that our irrational exuberance around painkillers is matched by the rising heroin crisis. and so i am convinced that if we went back to the old policies on pain medicine, which is when someone has chronic pain, treat it. and treat it hard.
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but don't pass this stuff out as if it's not a problem, which is what we're doing. you know, i'll give you an example and i know we can all tell these stories. but the other day i had a reporter come into my office and she just had surgery for cappal tunnel or whatever we all call it, how many did you get? she said, what do you mean? i said, how many oxys did you get? she said 80. how many do you take? less than half of one. so you have some left behind. the head of health care daughter's come by, she's a sophomore in college, she had four molers pulled out. did they give you any painkillers? what did they give you? oxy. how many did you get? 40. how many do you take? she said none. so, there's 40 more. and my point is, there's no question that when we made it tamper resistant, folks went to the pure heroin because it's
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cheaper and it's easy to get. but we cannot lose sight of the fact that we're not having this problem prior to the invention of oxycontin. we just weren't. and we got to go back to the source. i think as the senator from illinois said eloquently, listen, i mean, mr. member, i mentioned zohydro, when the fda approved it, its own advisory panel, 13 members, i believe, voted 11-2. fda, do not approve this drug. they did. so, my point is, there is a correlation if you talks to folks who are addicts, which i've done and many, many times, 80% of the times folks say to me, i got in a car accident, i had surgery, this happened to me, knee, whatever it was. that led me into this mess. >> senator shaheen wanted to add something. >> i did. i think we've talked about the fda, everybody here has talked about pharma and the role of
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prescription drugs. but what we haven't really talked about is medical schools and doctors. it's my understanding that most medical schools don't have any courses on prescribing medication, on recognizing drug abuse, and it seems to me that we've also got to get some attention from medical schools who are turning out doctors who are doing these prescribing practices without the history of what has been raised here at this hearing. >> amen. >> senator ayotte? >> i certainly fully agree with senator shaheen on this. we have to engage the medical community on this, but also, for example, in new hampshire back when i was attorney general i was fighting for prescription monitoring then, and our state was late to the game on it because we do -- when we look at this data and getting physicians the information that they can have -- and that's one of the pieces of this bill is to support the prescription monitoring programs. physicians that want to do the right thing it gives them the
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data to understand if someone's doctor shopping. it also gives us the focus to know if a particular doctor is actually exceeding his or her bounds because it's all focusing on them. and so that allows us to address that. but we have to engage the medical community. and i think samhsa who you'll hear from will tell you as i understand that some of the work they've done nationally four out of five people started with overusing or misusing prescription drugs. and to your point, chairman, that you raised in your opening, we also right now with the patient survey are actually encouraging reimbursement based on how satisfied people are with pain and that has to be addressed as well. and i know that cms is looking at this, but it has to be a priority because we don't -- and this was brought to our attention from doctors who are concerned that if they're worried about an addiction issue, they're being judged on a survey that's saying how do -- how's your pain satisfaction? so that has to be addressed as well. >> senator portman and then senator klobuchar.
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>> just quick i haly, mr. chairi don't disagree with the comments made here. we not only have the drug monitoring programs which are incentivized and to the question how the states will respond to this legislation it doesn't mandates the states to do it but it provides incentives and to your point that every state will be a little different and some states have done cutting-edge work and they should be the laboratories in democracy on this but we're helping them on this prescription monitoring program. including across state lines. in our state we may have a great program, in southern ohio west virginia and kentucky have different things. and we have legislation on that. second, this drug takeback program is incentivized in this legislatation, so it focuses on getting some of those drugs off the shelves which governor shumlin is absolutely right. the final thing i'll say, though, having talked to, you know, hundreds of people who are recovering, who have been
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addicts because of prescription drugs, i understand that issue very well including the athlete i talked about earlier. but i will also tell you there are a lot of people i talked to who jumped that step and went straight to heroin and holly is an example of that as we'll hear later from her mom. and i think now because heroin is so plentiful, i was just with the fbi in ohio yesterday talking about this the drug cartels from mexico are in ohio, they're in illinois, they're in our states because it's so plentiful, because it's so cheap, it's not just about prescription drugs anymore. it has been a gateway for a lot of people but now there is a problem we have directly with heroin even first use. and back, you know, in the days when we worked on this issue of cocaine and marijuana back in the '90s, heroin was not a first-use drug. it was a drug you would use after you had other gateway drugs typically. with young people as young as 13, 14, 15 years old they are using heroin today. so, this legislation is
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comprehensive. it does deal with the prescription side but it also deals directly with the heroin issue which sadly we now have to confront perhaps because of this onslaught that came from the overuse of pain medication. but now the heroin is upon us. >> senator klobuchar? >> thank you very much, mr. chairman. i'm proud to be an original co-sponsor of this bill with senator whitehouse and senator ayotte and yourself, senator portman. i just want to say -- get to this point about what we should really be looking at here and what we have some control over in the congress. i'm a former prosecutor. i know that these drugs have been coming in as you've stated, senator portman. but i think the number one thing that we can do right now in addition to funding our law enforcement and making sure we have efforts with dea funded, is really go after what's been happening with prescription drugs. because while it is true that there are people that originally get hooked on heroin, the facts are the facts as senator ayotte just said, four out of five, that's 80%, this is the last statistic i had, four out of
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five of these heroin users started with prescription drugs and what the governor's been telling us, what senator durbin is telling us here, this is different when it was even when i started as a prosecutor in 1998. this is a different situation. we have these prescription drugs -- i bet everyone in this room either has some in their cabinet, has had some in their cabinet or knows someone in their family where you just took one or two as the governor pointed out and there's 20 left or there's 30 left and they are sitting in there. senator cornyn and i passed the prescription drug takeback law years ago. we finally got the rules out of dea so we could get that moving but that is not going to solve it if it just keeps happening over and over again. in this bill are the work that senator ayotte and i did on the prescription drug monitoring. but just having come from a state here where we're not just the land of 10,000 lakes but 10,000 treatment centers the home of hazleton-betty ford, i know from talking to those doctors and experts that we are
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not really going to change this until we change the way the painkillers are given out and that's why the doctor monitoring, the having more limited of dipension of these kind of drugs is going to make the biggest difference here. because i am all in on trying to do everything we can to keep these dangerous drugs out of our towns, but the change here and what we have more control over is how we get these people hooked on drugs in the first place. and sometimes they are such innocents. they just have a bad back. and no one warns them that given their particular makeup if they take these drugs for four days instead of maybe just one day or maybe just one they're actually going to get hooked. we are doing this in our country. our policy. not a drug dealer on the corner. so, that's what i think we need to focus on and that's why i'm pleased with this bill. >> senator sessions? >> i think senator klobuchar is correct. it was an important point, there's a report over at "the new york times" it's written an online book that says these
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pills delay healing. the pain pills. the more you take, the longer you have these problems and he had a lot of points that we really need to reduce the amount of prescription drugs out there. as a former prosecutor myself, we targeted prescription drugs in mobile, alabama, that most -- it can be the most successful reduction of drugs there is. because there are not many sources. only certain doctors were way over the list. we found really the illegality was coming from drugstores, two drugstores. so, when you eliminate that, you don't plea bargain with people until they tell you where they got their pills, you can pretty quickly go right back to the sources that are out there. this is a winnable thing. and it does lead to additional drug use, so thank you, mr. chairman. >> thank you, chairman grassley and ranking member leahy. i hope the american people notice the striking bipartisanship this panel has
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shown. senators and governor, the questions, the comments that we've heard from members of the judiciary committee, the input we've heard from senators who have worked so hard on this issue for a long time. my home state of delaware, like your states, like your states, is also struggling with an opioid addiction challenge that has translated quickly into a heroin epidemic that has penetrated every level of society and every background and i have stories i could share about our local law enforcement and paramedic and first responder community. i'm just thrilled to be able to support a bipartisan bill which lays out the sort of authorizing background for expanding prevention, supporting recovery and senator shaheen's emergency supplemental to make sure we've got the legal framework and the financial resources. this is a genuine problem in all of our states. and it's my hope that folks who are watching recognize you've got republicans and democrats working together to craft a thoughtful, broad strategy and it's my real hope we will get these bills moved. thank you, mr. chairman. thank you, members of the panel.
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>> we've had a forceful discussion. very seldom do our colleagues get involved with questions from their colleagues, and thank you all very much for your patience. i'm going to move on to the second panel now, and i -- i know that i don't have to tell you that we'll be talking about this in the future because you're going to make sure we do. okay. the second -- while we have commotion, i'm going to call the second panel. our first witness is michael botticelli. director drug -- the national drug control policy at the white house. as director he heads the obama administration drug policy efforts and is responsible for creating the annual national drug control strategy. previously he served as director of substance abuse services massachusetts. he has an undergraduate degree from sienna college and a ma master's of education st. lawrence university.
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second witness dr. nora volkoff director of the national institute of drug abuse which supports most of the world's research on health aspects of drug abuse addiction. previously she worked at the department of energy's brook with haven national laboratory where she held several leadership positions. she earned her medical degree at the national university of mexico. our third witness, she serves as the acting administrator substance abuse mental health services administration. that agency leads public health efforts to advance the behavioral health in our country. she has worked at samhsa since 1998. earned a bachelor's degree and a master's degree in psychology from ucla and is also a graduate of harvard kennedy school government. our final witness is louie
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melahone deputy assistant administrator office of division control within the drug enforcement agency. in that position he's responsible for overseeing and coordinating major pharmaceutical and chemical division investigations, drafting and promulgating regulations. he's been with the dea in multiple capacities since 1997 and holds a b.a. from villanova university and j.d. rutgers. we will go with the way that we introduced you, so would you please start out, and you appeared before our committee many times. thank you for returning. >> thank you, chairman grassley. members of the committee, thank you for the opportunity to be here today to discuss the issues surrounding opioid drugs including heroin and fentanyl in the united states and our response. as you know this is an important
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issue for president obama. during his state of the union address earlier this month the president specifically mentioned addressing prescription drug use and heroin as a priority. and an opportunity to work with congress on an issue that transcends party, income level, gender and race. i also want to thank many of the members who are here today for their ongoing leadership and support for the work of our office on this most pressing public health and public safety issue. the office of national drug control policy produces the national drug control strategy which is our blueprint for drug policy. using our role as coordinator of federal drug control agencies in 2011 the administration released a plan to address the sharp rise in prescription opioid drug use. this plan contains action items categorized in four areas many of them already discussed today. education of prescribers and patients. increase in use of prescription drug monitoring programs. prorer medication disposal and law enforcement efforts. since this plan was released
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this crisis has clearly evolved with an increase in heroin and fentanyl use and overdose deaths and the administration has put forward new initiatives to help deal with emerging issues. as all of you know and have all indicated we need a comprehensive and multifaceted response and coordination at the federal, state, and local levels. opioids are taking a horrific toll on public health and safety in countries across the united states. we all talked about the staggering numbers so i won't repeat them here. these numbers are harrowing, however, but we are making some progress in addressing prescription drug misuse. past month nonmedical use of opioids by americans 12 and older was significantly lower in 2014 during its peak in 2009. the number of people initiating nonmedical use of prescription pain med -- relievers in the past year also decreased significantly. this progress, however, has been counteracted by an increase in the availability and use of
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heroin. although nonmedical prescription opioid use continues to far surpass heroin use. heroin purity has been rising while prices have remained low. and this heroin crisis has been compounded by the reemergence of elicit fentanyl a powerful synthetic opioid that is sometimes added to heroin. since it's far more potent, it has increased risk and increased overdose death in the united states. although the transition from nonmedical prescription opioid use to heroin occurs at a very low rate, a recent article concluded that this transition appears to be part of the progression of the disorder among those with frequent, nonmedical prescription opioid use or dependence. we've all talked about the need for enhanced prescriber education and graduate medical education programs because they do not provide a comprehensive focus on identification and treatment of opioid use or safe and effective opioid prescribing.
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in one of the most jarring studies that i have seen in my ten years in doing this work a recent evaluation of health care claims data found that a majority of nonfatal opioid overdose victims were receiving opioid at the time of their overdose and most alarming 91% of them received an opioid again from a prescriber and 70% from their own prescriber before an overdose. in response last year president obama issued a presidential memorandum requiring all federal agencies to the extent permitted by law to provide training on the appropriate and effective prescription of opioid medications for their staff who prescribe controlled substances. the administration also continues to press and will continue to work with congress to pass mandatory prescriber education tied to controlled substance licensure. the administration has focused on several key areas to reduce and prevent opioid overdoses
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from prescription opioids and heroin including educating the public on overdose rink risks interventions. and working with states to promote good samaritan laws and connecting overdose victims and persons with an opioid disorder treatment. we appreciate that congress provided more than $400 million in funding in the fy '176 to address the epdimock idemiepide. our 2015 strategy focuses on identifying, disrupting and dismantling criminal organization who traffic in opioid drugs, working with the international community to reduce the cultivation of poppy, identifying labs creating dangerous synthetic opioids like fentanyl and we have also been enhancing our efforts along the nation's borders and have been actively engaged with the
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government of mexico on supply reduction issues to decrease the flow of these drugs in our country. finally, this past summer ondcp committed $2.5 million to the high-intensity drug trafficking area program to develop a strategy to respond to the heroin epidemic providing enforcement resources to address heroin threats across 15 states and the district of columbia. this administration continues to work with our federal, state, and local tribal partners and reduce the public health burden and consequences of prescription opioid, heroin and fentanyl. and i want to thank you for your ongoing commitment to address this public health, public safety concern. thank you. >> thank you, dr. botticelli. push the red button. >> good morning, everyone. and i want to thank you all for giving me the opportunity to participate in this hearing. what is at the nature of the problem.
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chronic pain is among the most prevalent and debilitating medical conditions with over 30% of americans suffering from some form of chronic pain. the effectiveness of opioid an na analgesics and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid pain medications even when the benefits for chronic pain are questionable. what is no longer questionable is that opioid medications are being widely diverted and have produced an epidemic of opioid overdose deaths and addictions including those from heroin. opioid medications such as oxycodone and hydrocodone are diverted and abused because just like heroin they bind to opioid receptors located in regions of
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the brain which regulate pain which is why they are so potent analgesics but they are also concentrated in brain regions which is also why they produce addiction. opioid receptors are also located in brain regions that control breathing which is also why they can produce overdose and death. so, how does nida help in the issue? nida supported the development of the three medications that are currently approved for the treatment of opioid addiction. methadone, and naltrexone. there is strong evidence for the effectiveness of these + opioid use disorders in the prevention of overdoses, in the prevention of infections such as hiv and hepatitis c and despite the strong evidence, less than 40% of those being treated for
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opioid addiction receive these medications. thus, expanding the access to medications for addiction is a critical part of the hhs strategy. towards this end, nida funds research to develop implementation strategies for the use of medications in substance abuse treatment programs, in the health care system, and in criminal justice settings. examples in health care include initiating the emergency room or integrating the management of these medications within infectious disease clinics. examples in the criminal justice settings include initiating treatment the month prior to release or the use of vivitrol a once a month infection that blocks the heroin or other opioid drugs thus interfering from rap


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