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tv   Opioid Crisis Hearing at Johns Hopkins Hospital  CSPAN  November 28, 2017 2:13pm-3:56pm EST

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maria as hurricanes and irma will not defeat the u.s. virgin islands. we want to use this time to thank him and on tuesday giving thanks to alt others who have contributed maria and irma will not defeat the u.s. virgin islands. we in the hurricane leaf. my brother's workshop, family resource center, community foundation of the virgin islands, st. croix foundation, virgin islands asap relief group, bloomberg philanthropies. love for love city. operation rebuild. dy olson, v.i.r. 3, tony rosario, u.s. vi boxing. operation rebuild of the virgin islands. and all the first responders and all the virgin islands who are staying v.i. strong. i yield back. the speaker pro tempore: the gentlewoman yields back. pursuant to clause 12-a of rule 1, the chair declares the house in recess until approximately 4:30 p.m. today.
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>> we're going to go back now live to coverage of the meeting on the opioid epidemic. this is taking place at john hopkins hospital in baltimore. >> probably need to prioritize so we can make forward progress. but i think a lot of the building blocks are there. we're very proud of the efforts here in baltimore that our health commissioner, who we'll hear from shortly, has undertaken to health care providers, institutions like johns hopkins and others are undertaking to change the trajectory on. this the obviously a heavy lift. -- it's -- on this. it's obviously a heavy lift. but these recommendations will help. i want to echo congressman
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cummings' concern in the way that the drug should be available as it should be and there's not price gouging. that does need a closer look. i was able and i want to thank you for the recommendation around co-prescribing of naloxone. we were able to get included in one of the bills that was passed last year the comprehensive addiction recovery act, a proposal for demonstration project on co-prescribing of naloxone. to examine best practices around that, your recommendations in running alongside that in a positive way. so we thank you for. that my question is this -- for that. my question is this. i would imagine that you don't think yet that the sense of urgency that needs to be in the country around this issue is there. but it's changing. as i move around in my district, i'm sure this is the experience of others, not only
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are you hearing about these tragedies that raise your awareness, but you're also hearing people say things like, you know, i went to my doctor the other day, i went to the dentist and they gave me a prescription for this oxycontin or something like that, and all i really needed was tylenol. so patients are starting to step back from this. so something's getting to them. there's beginning to be a level of public awareness around this. when will you look at the situation, based on your experience and being involved with this commission, and what will you see, what will be the indications to you that the level of urgency is where it needs to be among policymakers, that the level of education and awareness out in the public is where it needs to be? is it t.s.a.'s coming across the airwaves -- p.s.a.'s coming
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across the airwaves in a way that matches election time in a swing election somewhere? is it the president getting a briefing every monday morning on what the status is with all the steps that are being taken with respect to addressing this crisis? what are the indicators that you're looking for to say to yourself, we're starting to get it here? >> that's a really good question, congressman, thank you. i've been asked this before. someone in their remarks, i forget which member, said it, talked about this epidemic being in greater numbers than the aids crisis at the peak of the aid crisis in the mid 1980's. mr. christie: i was alive then. a young adult. and here's what i think. where are the marches? i remember the aids epidemic and i remember marches in every major city in this country. and in washington, d.c.
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with people marching to say, the government must do something to find a way to stem the deaths. and in this crisis there are many, many, many more people impacted than were impacted in the aids crisis. yet we have no marching. and i'll tell you that i think we will have seen that we've begun to remove the stigma of this disease, when the people who are impacted are willing to show their face and march and demand from their government a response. and i believe they don't march today because they are ashamed to march. because they don't want to be identified. i'm not talking about everybody. i'm talking about mass numbers. they don't want to march. they don't want to be identified. this having happened in their family. to their loved one. and i think that that's why we recommended a massive national
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advertising campaign, beyond p.s.a.'s. i will tell you, in new jersey in this year, whether he spend -- year we will spend $50 million on an advertising campaign in my state, to remove stigma and to let people know how to get treated. $50 million of state money. and the reason we're doing it is because i don't want people to be stigmatized anymore. for this. and to avoid treatment and avoid asking for help and avoid demanding that there be something done about this. i will tell you one quick story. my mother was an addict. she was addicted to nicotine. she began smoking when she was 16 years old. she smoked for 55 years. she tried everything she could to quit and she couldn't. what she inevitably was seen was diagnosed with lung cancer at 71. nobody said to me, well, your mother was smoking for 55
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years. she's known since 1964 that it can cause cancer, she's getting what she deserved. no one said that. people said, oh, we're so sorry for your mom. what can we do to help? let's recommend doctors or treatments. did she go to this hospital or that hospital? we're praying for you. they came and visited her. they consoled her and encouraged her. and i felt no shame in telling people that my mother had lung cancer and that her lung cancer was caused by smoking. i want to ask you, sir, if my mother was a heroin addict, would i have done the same thing? and would all those people have come to her aid and recommended treatments and help? would my dad have been willing to ask for that? i'll know that we're bringing urgency to this when those barriers go away. when people march to demand that congress and the president and their government, along with our private sector, find treatments to treat people who are addicted and to find ways
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for them not to get addicted in the first place by alternative medicines. i'll believe it when people are marching and showing their faces. and when that happens, we'll know we're on our way to a solution. that's why i firmly believe in my heart and the stigma is causing death. every day almost as much as the drug is itself. [applause] >> i yield back. >> the gentleman from maryland is recognized. >> thank you, chairman gowdy and ranking member cummings. thank you for having this hearing in baltimore. such an important area to all our members, on both sides of the aisle. welcome to baltimore. i want to acknowledge dr. wynn who has done a lot in the baltimore area. governor, i think you're at the right place at the right time. you were in local government. you were a prosecutor. you managed a major jurisdiction. that's kind of my life, local government and managing the jurisdiction, except i'm in congress and you're a governor. i really appreciate the fact
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that you have made this one of your highest priorities. when you leave office probably it will dominate your life for a while. there are a couple suggestions that i do have, though. and to make sure that we pull all this together. first thing, we have a major crisis, you've got to identify the problem. i think these hearings, we understand it, the deaths throughout the country, it's a national issue, it's not just in urban areas, rural areas, everywhere. but the part that i'm interested in, i'm be a appropriator, and -- i'm an appropriator, and one of the issues we have to deal with is clearly money. we have to have that. there's been a lot of money put into this. there are other areas as far as treatment and drug treatments, doctors, nurses, treatment sent, all those types of things. but i know in your report, which is a good report, i haven't read it, i've heard it and i've been briefed on it, there are a lot of recommendations. when you have that many recommendations you have to pick priorities. but i think for us to get to the level, those of us who are
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appropriators, we're going to have to find out what your recommendations are for money. especially from the federal government. we have to have a number. and i would hope that your committee or your staff on your committee can start putting together a report. the second thing, there's no question, you said the congress maintains the power of the purse. but in this situation, the president, who has within his power as president to free up funding as well, and i'm glad the president has made this a priority. but everything in life you have to have follow-through. and with your ms. rice:, i didn't know you knew -- with your relationship, i didn't know you knew the president for 15 years, that's even better, with your tenacity and experience in all the areas i talked about, i would like to know what your plan would be to work with his advisors, his administration to make sure we find out where we are as far as the money. mr. ruppersberger: our governor, and i praise him, governor hogan has dedicated $10 million per yoor for five
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years to fight this epidemic. i think other governors need to do that too. republican or democrat. his is not a partisan issue. so my question to you is, first thing, can you decide what the recommendations would be as far as funding are concerned, when we find that number, we will work with you. i will pledge to work with you as other appropriators to find a way to get congress to fund this issue and also to get the president. if the president has made this such a high priority, we're oing to have to influence him. we're going to have to get him to make this a high priority. >> sure. a few things. i think when you say the commission or my staff, i want to be clear. my staff is sitting right over there. mr. christie: my chief of staff, and the governor's office, with the main staffer, we were not given staff on this. we had some support from ondcp.
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but the work that you see in that report is the product of the commissioners. we did not get into an amount of money. i didn't think it was our prove ints to do that -- prove ins to do that. we laid out the -- province to do that. we laid out the priorities that we think are important. we believe every one of those is an important priority. i know from personal experience that governing is chution. but the choosing now needs to be done by the president and the congress, not by an unelected commission. we've laid out all the things that we think need to be done in both near term and long term. now i really believe it's up to the leadership of the congress and the president, along with appropriate cabinet members to sit down and say, how do we implement this plan? how do we want to do that? and i don't think -- listen. i've done this stuff as a governor. but no one elected me to do this. and i really believe that all of you are the ones who have both the authority and the
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responsibility to do it. i'm happy to identify the problem and identify solutions. and bring a practical opinion to it. but i don't believe it's my realm to talk about how much. mr. ruppersberger: i respect you and what you've done. but you're the man. if you can't do it, nobody can. mr. christie: i'll have you call my wife and tell her that. [laughter] mr. ruppersberger: you have the expertise. you're an advocate. you've committed. but if you don't have the money, it's not going to work. mr. christie: i agree with you. mr. ruppersberger: we need you to be not only the advocate, we need you to be the lobbyist. we will work with you. we -- i will -- democrat and republican staff, i guarantee you on the appropriations committee, on the house side, we'll come together. but we need your expertise and your advocacy, especially when it comes to this president. mr. christie: sure. listen, as i said to both mr. cummings and chairman gowdy, i am and will continue to be available to all the folks on this committee and other members of congress who care passionately about this issue, to give you my advice, my
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counsel, my opinion. and to be an advocate. i'm going to continue to be an advocate. no matter who's in the congress, no matter who's in the white house. i've been an advocate on this issue for 22 years. i'm going to continue to be an advocate on this issue because in my heart i believe the most important role of government is to protect the health, safety and welfare of its citizens. this is right at the core of that. i don't know if i like the phrase lobbyist that you threw in there at the end but i will certainly be an advocate. mr. ruppersberger: persuader. mr. christie: i'll be an advocate for this. and i've been an advocate with the president all along and i'll continue to be. mr. ruppersberger: my time is up. my staff, i want to reach out to your staff to find a way, how we can start working on the numbers. that's end game. mr. christie: look forward to it, sir. mr. gowdy: the gentleman from maryland yields back. governor, thank you on behalf of everybody, not just for being here and sharing your perspective today, but for the hard work that the commission did.
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i go last when it comes to questioning. i want you to -- while we appreciate the audience that is here, they will be in the upper echelons in terms of engagement and education and i want you to think of broader audience, broader jury. our fellow citizens that have heard about the epidemic, perhaps someone close to their family has been touched by it, but they don't live and breathe it every day. as i listened to your opening, can put physicians i guess in one of three categories. vast majority of physicians are incredibly well intentioned and they're well trained and well educated and they do it the right way for the right reasons. then you have a group that is equally well intentioned but they lack the education. and you made reference to continuing legal education, continuing medical education. there is that group. and i don't know how big it is. our perspective is swayed by being prosecutors. there is that group that is profiting from people's addiction. and i don't see the diversion
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cases being prosecuted like i did in olden days. am i missing it? did y'all find it? mr. christie: i don't think you're missing it. i do think that there has been, over the course of the last decade or so, a de-emphasis on that priority. nd i think it's a mistake. i often think, mr. chairman, that folks believe that to emphasize one issue is to de-emphasize another. right? so, in new jersey, for instance, we've done broad criminal justice reform that has lowered our prison population more than any state in the country. during my time as governor we've closed two state prisons. yet our crime rate is down significantly. in our state. that doesn't mean that i don't want to see my attorney general continuing, and he has, to continually aggressively pursue the drug dealers in our state who are killing our people.
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i think that sometimes justice departments, which we both have been members of, think that if you're in favor of criminal justice reform, you can't be in favor of aggressive prosecution of criminals. or if you're in favor of aggressive prosecution of criminals, you can't be for criminal justice reform. i don't believe that. i think as a governor, the probably even more than as a prosecutor. the federal government in my view over the last decade has dropped the ball on these cases. and i think that it is contributing, not causing, but contributing to the problem that we have today. and that's why i'm not in favor of shortening the leg on the stool of enforcement interdiction. we need to continue to do that. i've shared that opinion with general sessions and i believe he understands that piece of it. but that message has to get out to the u.s. attorneys. and that can only come from the attorney general and the deputy attorney general. you and i both know, when you're a u.s. attorney, it's
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kind of like being a captain of a ship out at saturday. sometimes the radio works from the shore and sometimes maybe you can't hear quite as loudly. we need to make sure the radio's working on this one. and that u.s. attorneys are not given an option or are given a directive from their boss. the attorney general of the united states. that these are important cases to do. that doesn't lessen our commitment to providing more treatment. it doesn't lessen our commitment to confronting the chinese, what they're doing, using our foreign policy tools, in addition to law enforcement, to doing that. and it doesn't mean that we don't meevebloob -- believe they'dcation and prevention are really important. we didn't talk about that today. but let me say, in conclusion here from my perspective, that if we don't start talking to our children in the middle school about this issue, whether he lose them. and it's frightening to me as a father. to think that my 11-year-old and 12-year-old daughter or son needs to be spoken to about this issue in stark terms, but
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they do. we can't do it anymore. i spoke with the department of education. they were very proud. they showed me when i first came, oh, we have this new pamphlet that we're going to be giving out in schools on this issue. and looked at it and i said, so, listen, it's a great pamphlet. i read it. a lot of good information. i said, if my kids got this pamphlet, it would go in their backpack, by the end of the school year it would be at the bottom of their backpack and they'd never read it. because if it's not on here, they don't read it. we need to modernize the way we're educating our children. we should be demanding of companies like google and facebook, who are so predominant players in communication today to our young people, that they step up to the plate and start educating our kids on the things that we need to do. so what i say to you is, we have dropped the ball in my view in the last decade. since i've left the justice department in 2008. in doing these cases. we need to do this them.
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we also need to make sure we're doing the other things as well. this is the bipartisan nature of it and i believe that mr. cummings agrees with this as well. we've got to get rid of our old barriers on this issue. to think if you're for one thing, you must be against the other, vice versa. we can do both and we must do both. and there are people of goodwill and great experience who are ready to help to do this. and i hope that they're called upon to do it. and i count myself as one of them. and i will allow myself to be called upon to do it. i think you make a very good point, mr. chairman. and i think we need to make sure that we don't get caught in the traps of mutual ex clues ity -- ex clues -- exclusivity. mr. gowdy: i want to finish up with drug corps. we agree on that. if you want to not only have your own life changed but see other people's lives changed, attend a graduation for a drug
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court. that graduation ceremony will be with you for the rest of your life. i want to mention one kind of a niche issue there at the end. i also want you to address -- what barriers did you find, if any, for the pharmaceutical alternative, nonaddictive pharmaceutical alternative, what are the barriers to either having them researched, developed or to market? mr. christie: i don't believe they're going to be profitable. i think that's the single biggest barrier to it. that's why i believe bringing n.i.h. in as a partner to be a fair broker of the compact, to say which ones are most effective, and let's move them to the front of the line. and allow them to go to market and let's see how it goes. what i say -- listen, you know that new jersey has more pharmaceutical companies than any state in the country. i'm very sensitive to the importance of the farm suit cap industry, the role that they -- the pharmaceutical industry,
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the role that they play. i'm an advocate for the farm suit cap industry. but what -- pharmaceutical industry. but what i remind them is they have a social responsibility that goes along with that. and that to stand by and not develop these compounds purely on the basis of concern about profitability is to, in my view, walk away from part of their social responsibility as a corporate citizen in our country. n.i.h. needs to be a fair broker in this so the right compounds get the right money spent on them to develop them. but what i heard from them was the biggest concern was an issue of -- with the money that they have available, is this the best way to spend that money for our shareholders? and that's an absolutely legitimate if you douche year concern that they need -- if i doucheary concern that they have -- fiduciary concern that they have, but they also have a social responsibility as well. what we did say to the companies is, would you trust n.i.h. to be a fair broker on saying, ok, all 43 of these
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compounds need to be developed but these five have real potential to be nonaddictive pain relief and/or great medication assisted treatment to help those who are already addicted. the pharmaceutical companies agreed to submit their compounds to n.i.h. what we need to make sure now is that n.i.h. has the funding to make sure that they complete that job. if they do, i know dr. collins is really committed to this. if they do, we're going to get some of those compounds onto the market. that's going to help significantly. because i know physicians who would much rather prescribe a pain reliever that is nonaddictive but effective rather than one that is addictive. mr. gowdy: you mentioned social responsibility. in addition to being a colleague, one of my favorite colleagues in the entire body, peter welch, is also a former public defender. and his clients would have been incredibly fortunate to have him.
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in south carolina i saw sometimes in the state system public defenders would opt for straight probation as opposed to drug court because it was easier. now, that is not in their client's best interest. their client will remain an addict. but they're right. straight probation is easier than drug court. how do we develop around the grant strategy in sending the defense attorney, the public defender, to encourage their client to go get help as opposed to just being on probation for the next 12 months and remaining an addict? mr. christie: in new jersey what we did was we took away the option. you don't have the option of probation anymore. your option is this. go to treatment or go to jail. now, when given that option, it's kind of a gentle encouragement i'm known for, mr. chairman. [laughter] we had a lot of people in our state who opposed that. said hour dare do you that. if they're not ready, they shouldn't go. i said, i've never met an addict who's ready.
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i've never met an addict who's ready. i i've done interventions. i had a great friend of mine who sat there and argued with me that i was wrong that he was addicted. he didn't need treatment. he was fine. well, he's dead now. and the fact is, i've never met an addict who is ready. one of the things you can work out from a grant structure perspective is to say that we want to encourage those programs that don't give an ofplgts you don't have a probation option. i know exactly what you're talking about. that was happening in my state before we passed this law. now defense attorneys have a really easy equation to give their clients. you can go to drug court and go into treatment. or you can go to state prison. and what we're finding is, most people are choosing treatment. even when they don't think they're ready. what's happened, you talk about drug court graduations. the miracle of those drug court graduations is, in my mind, not the young men and women that -- and older men and women that i'm sitting with on stage.
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it's looking out in the audience at their families. their lives are hopeful again. their eyes are lit with joy for the restoration of a life. that they initially brought onto the earth. and which they had almost given up on. from my perspective the drug court, and why i advocated for every federal district in this country, is because i've watched it change lives and so have you. and fleece reason, even though there are fewer cases on the federal level that would be appropriate than on the state level, there's no reason we should have our federal prisons filled with people who would be better off being treated for themselves and for us as a society. the recidivism rate, as you know, for drug court grass, goes down significantly -- graduates, goes down significantly. that's what we all want anyway. we'd much rather spend less money on collections and b.o.p. than we would on other issues that are confronting our country in a time of limited resources. if we can lower the prison
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population like we've done in new jersey and close two straight prisons in eight years, i defy to you find any other state in america that's closing state prisons with its crime reduction. and it's because we're treating folks who have this problem like they have a disease, not like they have a moral failing. mr. gowdy: thank you for your passion and your expertise and i know mr. cummings would want to thank you also as we transition from your panel to the next panel. thank you. mr. christie: thank you very much. thank you for inviting me. [applause] mr. cummings: thank you very much. just one thing. our good colleague from maryland, mr. delaney, has a phrase. that i wish i had invented. he said, the cost of doing nothing is never nothing. and you've given us a blueprint. now we have to act. thank you very much. mr. christie: thank you, sir. appreciate it very much.
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mr. gowdy: the committee will come to order.
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we are pleased to welcome our second panel of witnesses. we have dr. richard, acting director of the office of national drug control policy. dr. wynn, the health commissioner for the baltimore city health department. and dr. alexander, co-director of the center for drug safety and effectiveness in johns hospital kin bloomberg school of public health. all.- welcome to you i'm not going to swear you because i didn't swear the first witness. so, i'll violate committee rules there and hope that nobody knows that i've done it. [laughter] we're going to call on you is he consequentially for your opening statements to the extent possible, limit those to five minutes. understanding we have a full body of your opening statement the record and then we will
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-- once alexander gives his opening statement, then we'll recognize the members for their questions. with that, dr. balm, you're recognized. >> thank you, mr. chairman, mr. cummings. thank you for inviting me and i'm really honored and pleased to be here for this important hearing. you're all familiar with the problem we face because you see it in your districts. this epidemic knows no geographic, political, socioeconomic, or racial bounds. we have very mindful of the fact that your constituents share heartbreaking stories with you about the loss of too many of our countries sons and doctors. mr. baum: we're committed to working with you to turn this awful crisis around. this truly is the worst epidemic in american history. as has been referenced in earlier testimony, we've seen over 60,000 drug overdoses in 2016. mostly caused by opioids such as heroin, fentanyl and prescription pain medications. it's often being pressed into counterfeit prescription pills complete with fraudulent manufactures' logos. we are not getting enough
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people of addiction into evidence-based treatment. our whole system to response to overdoses and other outreach efforts has to move faster to go out and find the people that need help. once people go through detox or treatment, they need ongoing recovery support, as well as help with sober housing and employment so they can fully rebuild their lives and reintegrate into society. we also need to ensure law enforcement agencies have the tools they need to reduce the drug supply and disrupt this mant -- and dismantle the drug trafficking organizations that threaten the health and safety of our people. the administration is work hard on multiple fronts to address this crisis. as you know, president trump has been vocal about the drug die sis, both during the campaign -- crisis, both during the campaign and since taking office. when he established the commissioner to look at additional action the government can take to address this epidemic. ondcp was tasked with providing policy and administrative support to the commission. i have the honor to serve as the executive director of the commission and ondcp staff contributed their expertise and
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time to assist the commission with its work. totaling more than 5,500 total staff hours. on november 1, the commissioner released its final report which included 56 recommendations as governor christie just described. the recommendations have now basketball circulated to all the agencies of the administration for careful consideration. i'm glad to say that the administration's already working on a number of them. president trump declared the opioid crisis a national public health emergency, as the commission recommended in its report. and he's mobile itesed the entire administration to address the crisis. h.h.s. has announced a proactive policy to allow states to waiving the decades old ban on reimbursements for patients receiving treatment sfailts. newtown and new jersey have already received approvals and we hope to have many more. in terms of reducing the availability of these illicit drugs, the administration halls take an number of steps. we're working with the chinese government to reduce the flow of fentanyl to the united
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states. this includes getting additional advanced electronic data from china on packages mailed into the u.s. this summer d.o.j. took down the dark web marketplace and other sustained actions like this over time will reduce trade over the internet that has been threatening the health of our citizens. the heroin response strategy, which is the initial of our program, is bringing law enforcement and public health together to quickly respond to overdose at the local level and to increase law enforcement efforts. and the f.d.a. is working to make prescription opioids safer and led the effort to remove the opioid medication upon extended release from the market since it was frequently being diverted and abused. the administration is provided significant resources to address this crisis. for n.q. 2018 the president reported $28.7 billion drug budget overall, including $10.8 billion for drug treatment. this year we've already seen $800 million out in states.
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the president has requested $500 million additionally to help states expand access to opioid treatment in the f.y. 2018 budget. and at ondcp we're developing the trump administration national drug control strategy, which will be out early next year. we're using all the tools in the tool box to make headway against this enormous problem. which is affecting every state and many of your constituents in some way, shape or form. i've not had the privilege to visit south carolina. as acting director. but i've visited maryland and i've seen how people in these communities are coming together to address this crisis at a local level. this is a critical part of our country's response to the epidemic. as i said, this crisis is unlike anything we've seen before. working hard to address it. but we have a lot more to do. i thank governor christie and the commission for their recommendations wlirks help to this end. i also want to thank the dedicated ondcp career act for so skillfully completed the
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commission's work and i thank the committee for holding today's hearing on this important matter and i look forward for this discussion and dialogue. thank you very much. mr. gowdy: thank you. dr. wynn. ms. wynn: thank you for calling this hearing in our city of baltimore where today two residents will die from overdose. our aggressive approach to this epidemic has three pillars. first, we save lives by making the opioid antidote available to everyone. not only have we equipped paramedics and the police, i issued a blanket prescription to all 20,000 residents. since 2015, everyday individuals have saved the lives of 1,500 people. but our city is out of funds to purchase naloxone. as congressman cummings mentioned. forcing us to ration and make decisions about who can receive those antidotes. at a time of a public health crisis, it is unconscionable that we are being limited in our ability to save lives. second, we aim for on demand addiction treatment because the science is clear. addiction is a disease and
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treatment works. but nationwide, only one in 10 people with addiction get treatment. imagine if only one in 10 patients with cancer get chemotherapy. as an emergency physician, i see patients coming to the e.r. all the time asking for help. but i tell them they have to wait weeks or months. my patients have overdose and died while they're waiting because our system failed them. we are expanding treatment. third, we reduce stigma and prevent addiction. treating addiction as a crime is unscientific, inhumane and ineffective. but why are public health and public safety agencies collaborate closely including to pilots law enforcement assistance diversion while
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those that have small amounts of drug get prosecution instead of treatment? we are trying to address trauma and provide mental health services in our schools. my written testimony has point-by-point analyses of the president's commission's recommendations. i agree with many of them but they do not go nearly far enough in four areas. first, the commission did not identify substantial additional federal funding. we're in the front lines -- we in the front lines know what works. we dess netly need -- desperately need new resources. these funds should also be given directly to communities of greatest needs. cities that have been fighting the epidemic for years and we shouldn't have to jump through additional hoops. competing grants and having them pass from states to cities will cost time and many more lives. second, the commission failed to advocate for taking all necessary steps to expand
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health insurance. one in three patients with addiction depend on medicaid. if medicaid were gutted and they were to lose coverage, many more would overdose and die. other patients on private insurance could find themselves without treatment as addiction is no longer required to be part of their health plan. it's estimated that a.c.a. repeal could result in three million people losing access to addiction treatments. block grants should not replace insurance coverage because no disease could be treated through grants alone. third, the commission's recommendations did not guarantee access to treatment for addiction. it reduces the likelihood of death, incidents of other illness and criminal behavior. at the very least, medication assisted treatment should be the standard of care for all treatment centers, and we can go further if doctors can prescribe opioids that lead to addiction. why shouldn't hospitals all be required to treat this disease? third, the commission ignored evidence-based harm reduction
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practices. in baltimore needle exchange has resulted in the percentage of individuals with h.i.v. from injection drug use, decrease 2014. % in 1994 to 7% in our program are staffed by people in recovery themselves will help patients help with treatments. here in baltimore we know what works. we need support from the federal government in three ways. number one, urgently allocate additional funding to areas hardest hit by the opioid epidemic. number two, directly negotiate with the manufacturers of naloxone so communities no longer have to ration. number three, protect and expand insurance coverage to get to ondemand treatment for the disease of addiction. here in baltimore we have done a lot with very little. we can do so much more if we had more resources. and i urge congress to commit these resources so we can save lives and reclaim our future. i thank you for coming to our city and for calling this hearing. mr. gowdy: thank you, dr. wen.
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dr. alexander. dr. alexander: thank you, chairman gowdy, ranking member, members of the committee. i appreciate the opportunity to speak today. i am a practicing primary care physician and co-director of the johns hopkins center for drug safety and effectiveness at the john hopkins' school of bloomberg health. my focus focuses on policy solutions to the opioid epidemic. as a practicing physician i know the power of stories to show compassion and i'd like to share a brief one now. in 2011, judy lost her son, steve, from an overdose. i work with judy on policy reform and i asked her if i could share his story she said i'm always happy to share steve's story if it helps the cause. steve's journey began like so many with a lower back injury that led to chronic opioid use and subsequent addiction. years before his death, he wrote of opioids. at first they were a lifeline and they became a noose around
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my neck. steve tried as best as he could to get well and he didn't want to die but he ultimately succumbed to an overdose after discharge from a rehab facility. now judy keeps a picture of steve along with a note. if love could have saved you would have lived forever. steve's story and his family's resolve to ensure other families don't have to experience what they have is a reminder to me of what's at stake here and that the loss so many have endured. during the past year, my colleagues at johns hopkins and i reviewed hundreds of scientific studies and other data points on the epidemic. last month we released this report from evidence to impact that's been provided with my written testimony and that provides recommendations to address the epidemic. ranking member cummings, we were so honored that you participated in the release of this report in the remainder of my time i'd like to highlight two points how the commission's
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report can help best change. it provided a comprehensive framework for action. simply put, the science is the kines and the commission's -- science and the commission's report gets it right. it lines up closely to our own appraisal in most areas. both assessments agree providers should use prescription drug monitoring programs. the c.d.c.'s guidelines should be standard practice nationwide and high quality evidence-based addiction treatment should be available on demand. in my written testimony, i made specific recommendations regarding steps congress can take such as passage of the prescription drug monitoring act of 2017. and i also highlight areas where the commission might have increased the comprehensiveness or impact of their review. second, as we've already heard urged by some of you this afternoon, it's now critical for the administration to develop the strategy to support the implementation of its recommendations. it's one thing to say we are going to send a man to the moon and it's totally a different thing to have a plan in place
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to do so. in my humble opinion, the commission's two most important recommendations are that we need to reduce overprescribing and provide high quality evidence-based treatment for addiction upon demand, although i think reducing the supply of fentanyl in the country is a very close third. but i'd love asking the questions that some you may have, what are the specific steps the federal government is going to take to reduce, for example, opioid overprescribing? what resources are required? which agencies are responsible? what timeline will be followed? and how will we know when we've been successful? in short, we urgently need an implementation plan and this committee would support this effort by asking for and reviewing such a plan for the commission's most important recommendations. this committee can also exercise oversight capacity to ensure other federal agencies acts on the committee's recommendations. esteemed representatives, we're losing half a million americans
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from overdose that should be with us today, people like steve and so many others. incredibly more deaths from opioids are expected in 2017 than ever before. as we look to 2018, there are reasons for hope. providers are increasingly using safer and more effective treatments for pain. there's growing awareness that addiction is a disease and treatable and more americans are living fulfilling lives and recovery. communities are increasingly mobilized, demanding affordable naloxone, relyable access to addiction treatment, stronger f.d.a. regulation and coordinated federal action. this is a fixable crisis, but not without an implementation plan to accompany the commission's recent recommendations. thank you, again, for the opportunity to testify. i look forward to your questions. mr. gowdy: thank you, dr. alexander. the gentleman from maryland is recognized. mr. cummings: thank you very much, mr. chairman. dr. wen, on june 18, 2017, the
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baltimore sun published an article on naloxone entitled "baltimore city running low on opioid overdose remedy." the article stated that, quote, the city has about 4,000 doses left to last until next may. end of quote. you were quoted in that same article as stating, and i quote, we are rationing, we are deciding who is the highest risk and giving it to them. how many doses of naloxone does the city have left now, and is that number adequate to meet the city's needs? dr. wen: thank you, congressman. we -- mr. cummings: and who are the highest priority people? dr. wen: highest priority individuals that we allocate this lifesaving medication to are the individuals who are clients of our needle exchange. these are members who are actively using drugs. now, i will say we do not in
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any way condone drug use but we do believe in saving someone's life. if it's preventing the spread of hepatitis and h.i.v., we need to do that. if someone is dying today there is no way for us to deny treatment tomorrow. one unit is used to save someone's life. now, i don't know how many medical advances there are out there that have a number needed to save someone's life as one in 11. i have to, answer your question, i have about 8,000 units left between now and july of 2018. now, we are grateful for the work of our state. one is from the state. they have been gracious in providing additional funding for naloxone once they need -- they saw the need in baltimore city. if i could get 8,000 more i could get them out this weekend. in the middle of an epidemic, i shouldn't have to be forced to
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decide who gets to carry a medication that could save their lives or their family's lives. mr. cummings: so how many doses do you need? to adequately, adequately distribute enough to be effective, do you think? in other words, what is your goal? dr. wen: i want -- mr. cummings: your goal amount? dr. wen: i would like for everyone in our city to carry naloxone in their medicine cabinet or in their first aid kit. imagine if we had the remedy, if there ebola hit our city or some other horrible contagious illness were to hit our city, we would want to make sure every single person carried the antidote. i have community members, neighborhood faith leaders calling me every day asking for naloxone. why shouldn't it be available everywhere? and every public place the way we have defibrillators every place?
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mr. cummings: the baltimore sun said the price of a pop latin american jectable version jumps 500% in the past two years and the cost of a nasal spray use in baltimore has increased nearly 63%. one injector can cost about $4,500. but just two doses. is that correct? dr. wen: that's correct. mr. cummings: so dr. wen, what formulation of naloxone is your office using? dr. wen: we use nasal narcan which is manufactured by ada pharma. one of the f.d.a. approved versions of the medication. and we would hope that in this epidemic, if the federal government can directly negotiate the price so that we can get this at a much discounted one. mr. cummings: some kind of way -- we have spent a lot of time dealing with this issue of drug pricing and overdrug pricing.
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and it seems sad -- this is my conclusion -- that a lot of these price hikes is about greed. not about cost of research. r&d. but greed. at the same time we know we have something here that works. are there other things coming down the pipe that you know of that might be just as effective as naloxone? have you heard of any of those things? dr. wen: i have not. there are very few antidotes available in modern medicine. naloxone is on the list of essential medicine. it's available by the pennies in other countries. mr. cummings: by the pennies? dr. wen: in other countries. mr. cummings: wow. thank you very much. >> first question for all of you, on the break i ran into a woman down here that was very interesting who, you know, had a relative who had been through treatment.
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mr. grothman: dozens of times. which kind of obviously means the treatment doesn't always work. i'd like you folks to comment on percentage-wise how often in your experience and programs you deal with treatment works and what distinguishes the programs that are successful to those programs that are not successful? and also, what percentage of admissions do you expect to be successful with regard to treatment? >> well, i could begin and say that there's no question that opioid use disorders are really, really serious and individuals that have opioid addiction remain with a life-long vulnerability to the products. dr. alexander: and this is one of the reasons that it's so important that we reduce the overprescribing of prescription opioids in the first place. mr. grothman: i only have so much time. can you tell me percentage-wise in the treatment programs you are familiar with, percent
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-wise, how many times do they go into treatment and how often are they successful? dr. wen: the data i have seen is 30% to 60% rate of recovery recognizing that addiction is a complex disease. and that we need to be ready for people whenever they want to go into treatment. governor christie had mentioned he had not met people who are ready for treatment. i meet them all the time, and the problem is that we need to be ready for people at that moment. not have them weeks and months and then recognize relapses are part of recovery because that's the nature of the disease. mr. grothman: so you expect a treatment program to be successful half the time? in other words, half the time of a heroin addict or opioid addict goes in they will never do again, is that what your expectation is? dr. wen: they may not be successful that first time but may be successful that second time and recognizing that there are forms of treatment that are evidence-based and some that are not. and so we need to be promoting these evidence-based treatments which include medication
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assisted treatments. mr. grothman: when you get on the internet it implies these are wildly unsuccessful. that's why i'm asking you. mr. baum: i just wanted to add to that it's true relapse rates are a challenge but i think if we move away from the sort of isolated episodic treatment model to an ongoing continuing care we can drive down relapse rates. sometimes we have a detox program that's separate from an in-patient treatment that's separate from ongoing recovery support and we have to doing it that way. the system has to evolve to have ongoing recovery support so that we lapse rates are driven down. in summary i would say, we shouldn't accept the level of relapse rates. i think we can drive them lower if we work harder and smarter. mr. grothman: i asked governor christie. i will ask you as well. someone made the fact that heroin was apparently common in vietnam and when people came
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home the troops stopped using heroin. can you comment on that? mr. baum: it's a very interesting point in history. in vietnam is when they had the first drug testing program. and people weren't cleared to go home to vietnam until they tested negative for drugs. and so there was people in vietnam highly motivated to get home. they had stopped using drugs. they had to test negative and went home. i do -- i don't dispute the point that you change the environment and you change the behavior but it was also part of a program to test people and to encourage them to get off heroin before they came back. dr. wen: part of it, too, is why it is people are using drugs. part of it may be overprescribing because of treating physical pain. but people are also treating other types of pain too. we know that the same communities facing high rates of overdose are also facing poverty and homelessness and unemployment. and in order for us to break that cycle of addiction, we also have to be addressing those underlying factors and
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helping those communities drive too. mr. grothman: ok. you're touching on something i think governor christie wanted to stay away from. do you find sometimes family background is a correlation of abuse? dr. alexander: i think there's evidence that people in all walks of life, all types of background, at every level of wealth, every racial group are affected by the drug problem. mr. grothman: that is what i was saying. percent-wise? mr. baum: i think if you look at the percentage breakdown by socioeconomic group, there's a little bit variation. everyone is being affected by this problem. everyone with the disease and diction need ongoing recovery and support. mr. grothman: ok. that's it. on to the next. mr. gowdy: the gentleman yields back. the gentlelady from district of columbia is recognized. -- from the district of olumbia is recognized.
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ms. norton: i think you can hear me now. i think it's fair to say both democrats and republicans underestimated the standing of the affordable health care act until the most recent election. -- we saw governor-to-be govern-elect northham win an election and the polls say the lead indicator was the affordable health care act. people apparently are very afraid for their health care and they chose that election, hich is considered a kind of harold election for the coming
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elections to express themselves even though they knew that northham would have a hard time getting them the affordable health care act. my question is about what role the affordable health care act n play or is playing in this crisis? i know that governor christie indicated that the affordable health care act, unlike by the way plans that many americans have, does require that substance abuse be afforded in the same way as other health care. that's an important gain for health care in the united states, at least for those that have the affordable health care act. one of the figures that interested me was the one on medicaid expansion and who in fact has benefited from it. t appears that three in 10 nonelderly adults with
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substance abuse disorders nationwide get medicaid expansion. it's being used by the very people we are discussing here today. need to know from you, erhaps dr. wen, dr. alexander, what you think -- what you believe would occur if in fact those states that had medicaid expansion -- this is one of them, new jersey, governor christie's state is another, suppose that's no longer available, what would that do to the crisis under discussion here this afternoon? dr. wen: more people would die. because of medicaid expansion, 1.6 million people who have substance abuse disorders are now able to have access to treatment. prior to the a.c.a., 1/3 of the individual market plans did not cover substance abuse
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disorders. and for people who have the disease of addiction, there is no margin of error. if you are to take away their treatment today, their only option may be to overdose and die. and so studies have shown it will take $80 billion over a decade to pro-- $180 billion over a decade to provide health care for those that lose coverage. the point that ranking member cummings made, the cost of doing nothing is nothing. we are spending that money anyway. we are spending it in medical costs and cost of incarceration. we can choose to invest in treatment instead. ms. norton: is the form of health care being used to prevent opioid addiction and not simply to intervene once it occurs? dr. wen: we need to do a lot more when it comes to prevention, including stopping the overprescribing of drugs, stopping the trafficking of drugs. but also things like investing in nutrition. family literacy. home visiting. all those things also help to boost family structure and
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reduce poverty which ultimately also reduces addiction. dr. alexander: i would just add, although the a.c.a. was not designed for the treatment of patients with opioid use disorders alone, there are several provisions within it that have been very important for those seeking treatment for opioid addiction and that's not just the parody provision but also the requirement that treatments for addiction be considered an essential health benefit. so this is something that the commission speaks -- the commission report speaks to ways there may be barriers to accessing, for example, medicated assisted treatment but does not directly address the role of insurance in the first place. a colleague of mine has i think eloquently put it, until you make it easier for patients to access high-quality addiction treatment, then it is to find their next bag of heroin or
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their next bottle of oxycontin they won't go to treatment. i think treatment is important. ms. norton: why are so many jurisdictions worse off? for example, the district of columbia is a big city. they have used the affordable health care act, done a lot of prevention. the crisis i think over the last three years tripled. are there characteristics of a jurisdiction that will predict the opioid crisis that you could speak about, dr. alexander? dr. alexander: well, it's an outstanding question and indeed if you look at maps of the country, county maps, it's stunning the variation county-to-county both in terms of opioid prescribing as well as injuries and deaths from opioids. the first point i'd make is these are highly correlated. that is if i showed you plots, you don't have to have a degree in biostatistics to see there's a very high correlation between the volume of opioids that's being prescribed in a given
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area and injuries and deaths from these products. we do know there are a variety of different state policies and county policies that could make a difference in the volume of opioids that are prescribed and in rates of heroin and illicit fentanyl use. but i think there's a lot more we have to learn. not why it's so bad in counties but also we've seen counties that had remarkable gains in terms of reducing both the volume of overprescribing but also injuries and deaths from these products. and state policies like prescription drug monitoring programs, ensure policies and state policies like caps on the volume of prescription opioides that are prescribed, investments that cities and states are making and addiction -- in addiction treatment services, all these can play an important role. ms. norton: thank you. mr. gowdy: the gentleman from alabama, mr. palmer, is recognized. mr. palmer: thank you, mr. chairman. mr. baum, there was a report in
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e november, 2017, journal, addictive behavior, notice there has been a shift in drug opioid abusers first use. according to the report in 2005, 8.7% of individuals who began abusing opioids in 2005 began with heroin. 2015 that had changed to 33%. has your office been able to determine what caused this shift? mr. baum: you know, thank you for the question. i don't have a definitive answer but i would say the epidemic continues to evolve rapidly. we know -- i won't repeat what was discussed with the overprescribing of the narcotic painkillers. as more people have been using heroin, there's been a spread of heroin shared between family members, boyfriends, girlfriends, and others and so i have seen those reports and it is concerning. and let me just emphasize, we
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need to get out the message about the incredible lethality of the drug supply, when someone consumes heroin, it could contain fentanyl. it might contain other substances as well. same with these prescription pills that people buy, the drug ply is more lethal than ever before. and really people are taking their lives in their own hand when they are using these drugs. mr. palmer: dr. alexander reported there were 64,000 deaths in 2016. is that an accurate number? dr. alexander: correct, from all overdoses. mr. palmer: information i have is may have been underreported by as much as 20%. each of you touched on this a little bit because reluctance of family members to have that cited as cause of death, is that 20% underreporting, does that -- is that real?
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is that -- mr. baum: i am not sure of the precise degree which there's underreporting. dr. alexander: there is no doubt. you raised a very good point. any underreporting would mean that the epidemic is even more worse than the 64,000 number would suggest. mr. palmer: well, that's my point. the epidemic is at a point now literally reduced the life expectancy of americans. we for the first time -- i forget how many years -- but it's been at least a couple decades life expectancy in the united states has declined. and there's some studies indicate it's related to the number of people dying from drug overdoses, drug poisoning. dr. alexander: that's correct. we see manifestations in many different sectors of the economy. the labor force i think the commission's report did a good job of outlining many of the ripple effects. we heard about strains on the foster care system and so there
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are effects manifest throughout. the other point to make, deaths are tragic and i know many of you have met with constituents and you'll never forget those stories and those days and yet the deaths are the tip of the iceberg. for every patient that's died, there are dozens or more that have opioid addiction. there are hundreds that are experiencing the effects of going to emergency departments or having a chaotic household where someone has an opioid use disorder. mr. palmer: want to touch on something my colleague from wisconsin brought up and that's the efficacy of the treatment using medication assisted treatment. i think the number is -- it's not effected for about 40% of the population. i'll touch on -- but there's another drug out there, vivitrol, does not give the same impact as opioid. it's once a month type deal. it literally requires that
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people go into withdrawal for -- i mean, it takes three to 10 days for someone to become clean to use that. ve any of you used that, dr. wen, i guess that would be more appropriate to address that to you? dr. wen: yes. e believe that all three forms, methadone, vivitrol, all three should be available in all settings without there being private authorization for insurance. without one form being available at some places. just like for other illnesses, some patients may do well with one medication. some may do well with that medication but may do well with another one. we believe all three would be there. methadone had a bad reputation because they can be abused and misused. so can many medications. and we have to follow the science and the evidence which show that medication treatment is the gold standard in that it
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reduces illness and death and even criminal behavior. mr. palmer: i think my time has expired. i appreciate your responses to this. i just want to point out, though, this is not a political issue. this is -- it is in my opinion a public emergency. to bring the politics into it i think is inappropriate. we have seen a major increase in deaths from drug overdoses since 2010. i just want to encourage folks to not look at this as a political issue. this is a national crisis. i yield back. mr. gowdy: the gentleman yields back. the gentleman from missouri is recognized. clayton fejedelem thank you, mr. chairman. -- mr. clay: thank you, mr. chairman. if we are to be successful, i am african-american believer we must first -- if i am a firm believer we must remove the stigma associated with drug use. for far too long, society has
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deemed drug users criminals. in need of incarceration. rather than patients in need of treatment. as we saw so clearly doing the 1980's and 1990's. dr. wen, you summarize that change back in january stating, and i quote, traditionally it's been seen that if you have an addiction, it's a moral failing. it's a personal choice. now we are calling it a disease. doctors wen and alexander, how important is it that we as a society have finally -- are finally recognizing addiction for what it is, a disease? dr. alexander: well, i think it's vital and i think we heard this question posed which is, can you imagine if we told people with diabetes that 10 out of 100 will get treatment or we told people with kidney
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cancer, we'll take 100 of you and we're going to offer 10 of you the best treatment that we have? and it's when you look at settings like that when you realize the role that stigma has. another pervasive and underappreciated point is all too often we discuss abuse and i was heartened by the commission's report, the word addiction throughout. it's in the first sentence i believe. it's in the title, in the charts of the commission. this is an epidemic of addiction. it's not an epidemic of abuse. there is nonmedical use that takes place, but for far too long we suggested there are sort of two populations of individuals. we have the drug abusers that we need to do everything we can to prevent them from accessing the medicine. and then, you know, when i was a resident, i was taught we need not worry about the addictive potential of opioids if a patient had quote-unquote true or legitimate pain. and nothing could be further from the truth. so i think the issue of stigma is really front and center and
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think that this will take resources of massive scale, really, to continue to educate individuals who would choose a life of addiction. it's on anybody who really understood and met somebody that has addiction knows this isn't a choice that people are making any more than it's a choice of a 10-year-old to have type 1 diabetes. dr. wen: we would never say to someone with diabetes they should go to jail and if they -- not get treatment in jail but once they return they should be cured which is the type of stigma we continue to put on people who have the disease of addiction. i think one of the questions i would ask is about the communities that are the most heavily affected. our community here in baltimore has been affected for decades. this is not a new issue. and congressman cummings has spoken very eloquently about this in many talks past that we owe an apology to generations who we have incarcerated. and we owe an apology because
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we knew the science but didn't speak up then. mr. cummings: mr. baum. mr. baum: thank you, congress -- mr. clay: mr. baum. mr. baum: thank you, congressman. police chiefs and this was, they are doing be a incredible job around this country. they know the difference between someone who is a drug user, who needs treatment, and someone who is a drug trafficker, a major drug dealer who deserves punishment. it's no question that someone whose criminal activity is limited to buy and using drugs should be diverted to treatment. i've been really encouraged with the police diversion of -- that's happening around the country. prearrests. working very closely with police assisted addiction recovery. anyone can walk into a police or sheriff's office and get diverted right to treatment. they do a quick intake. they take you in front of the police car and drive you to treatment. this program is expanded rapidly. they are doing prearrest
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diversion than ever before. on the other hand, if someone is selling heroin laced with fentanyl to our citizens and causing overdoses, killing people, that's a serious crime and they deserve prosecution for that. i think we're able to tell the difference between those who need to be diverted to treatment and those who deserve prosecution. mr. clay: as well as those physicians who turn their offices into pill mills. mr. baum: no question there have been some abusive doctors who have been incredibly reckless and they deserve prosecution for those crimes as well. mr. clay: not to put you on the spot but is that the official position of the u.s. department of justice, or can you -- mr. baum: the department of justice wants to prosecute traffickers, criminals and those killing our citizens with these deadly drugs. there's no conflict at all for diversion, for minor, nonviolent offenders for treatment. mr. clay: thank you for your responses and i yield back, mr.
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chair. mr. gowdy: the gentleman from missouri yields back. the chair will recognize himself. dr. sdearned, you talked about self-prescribing one of the things you would address first. what are the causes of overprescription? is it a misdiagnosis? is it a failure to consider alternatives? what are the root causes of the overprescription? dr. alexander: well, thank you for the question, mr. chairman. and the commission's report discusses these in some detail and here again i think they hit most of the high points. misinformation. as i noted from my own training, when we were taught in the late 1990's that we had overestimated the addicted potential of prescription opioids, labeling that's inconsistent with the totality of evidence regarding the safety and effectiveness of these products. and of course the labeling, as you know, in turn affects the ways pharmaceutical companies can market and promote the
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products. the widespread prevalence of pain and the notion that pain needs to be fully abated and that people should, you know, get to zero on a scale of one to 10 rather than in many countries cultures where pain is something to be managed. i think many pain experts would say pain is something to be managed and lived with. not just grim and bear it but not expect that you're going to be taking enough opioids that you get down to a zero. there are many, many causes that have contributed to the overprescribing. mr. gowdy: are there certain specialties or subspecialties that you identified that the overprescribing is more prevalent? dr. alexander: well, it's a terrific question. it would be a privilege to be able to share with the committee some of our own data and own analyses in this regard. the point i would make is that the prescribing volume of opioids is highly skewed so that if you look, for example,
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within primary care physicians, it's a small subset of primary care physicians that account for the lion's share of opioids that are prescribed. with that being said, these are not primarily rogue prescribers that are down on main street seeing 300 patients in a day and only accepting cash. i think there's a very important point here and in fact governor christie spoke to it when he said most prescribers that are contributing to this epidemic aren't doing so out of ill-intent. they are doing so out of nonintent. so it's important to recognize that while opioid prescribing is highly skewed, that the prescribers that are prescribing such enormous volumes are not necessarily, you know, just throughouting any standard of best -- flouting any standard of best medical practice. mr. gowdy: when you think primary physicians i think internists, g.p.'s. what am i missing? dr. alexander: pediatricians,
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lower volume because fortunately not many kids are prescribed opioids. mr. gowdy: we can take pediatricians out of it. internists or -- internists or g.p. -- family doctors? dr. alexander: uh-huh. mr. gowdy: two questions in this realm. has there been any analysis of physicians who write prescriptions for opioids after a patient has been declined a prescription for -- from another physician? in other words, doctor shopping? dr. alexander: yeah, it's a terrific question. again, as with the rogue prescribers, when we look at the data we reach a very interesting conclusion which is that opioid shoppers are exceedingly rare and almost a rounding error in importance relative to other pop -- populations of high-risk patients. it's not that it's not vital that we intervene upon opioid shoppers but there are other populations of chronic opioid users that are at much higher
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risk when you look at a population level, at a public health level than opioid shoppers. i am speaking about individuals that are on chronic high dose opioids and individuals that are on the combination of escription opioids and benzodiazapenes. mr. gowdy: i have a couple more questions. i will do it so i don't violate my own rules. in terms of alternatives -- well, let me ask you this. we can test blood pressure, we can test cholesterol, you can check someone's temperature. how close are we to having a diagnostic test for pain? dr. alexander: it's -- you know, nowhere in our lifetime would be my best guess. i think it's one of the other factors that's contributed to the epidemic because it's really -- because pain is so intersubjective.
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it varies a lot person-to-person and it's very difficult. there is no objective test for it. this is one of the reasons that i think it's so important that we teach the next generation of professionals and those currently in practice, there are lots of tools in the toolbox. we don't need to just wait for the f.d.a. to bring new drugs down the pipeline 10 or 20 years from now. we already have dozens of different treatments, both farm uld he logic and nonpharmacologic. we are shining such a bright light on opioids that we are neglecting to consider all of the alternatives that in many cases are safer and more effective. mr. gowdy: the gentlelady from michigan, mrs. lawrence. mrs. lawrence: thank you. question to dr. wen. you talked about baltimore schools having addiction screening. we have approximately, as reported, about 430,000 foster
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children in america. i sit on the foster care caucus, and it's a high priority for me. ntal health for our foster children is at an alarming rate. they suffer five times more likely from ptsd and from trauma. with that being said -- and we talked about the priority groups based on the socioeconomics. is there any focus on foster children as far as education screening and support? dr. wen: excellent question. from -- we know from studies children who experience trauma, which losing their family certainly would be that trauma, or growing up in families with high rates of addiction would also be traumatic, too, that these children have higher rates of addiction themselves. and that is this vicious cycle,
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then of poverty, trauma and addiction and addiction begins to beget addiction. we need to provide services for those children experiencing trauma but critically we also have to provide treatment for their parents and caregivers because unless we do that we are going to have issues like we've had a tripling of the number of children born with neo natal abstinence syndrome. 40% of i.c.u. days are because of the child being born with with the opioid addiction themselves. that is a dangerous cycle. and we can stop it by providing treatment for the mother, for the parent, for the caregiver. mrs. lawrence: i am told by the department of human services that the fastest growing contributor to foster children growth in america is from opioid addiction because children are being taken away. the last thing i want to say is
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that i did enter a bill that would -- the timely mental health for foster youth, which would require all children to be mandated, like to get a physical health assessment. they do a mental health assessment. because we know these children experienced the first level of trauma and that's being separated from their family. host: as we continue targeting and addressing addiction screening that we keep a focus on our foster children in america. thank you. mr. gowdy: the gentlelady yields back. the chair would now recognize the gentleman from vermont, mr. welch. mr. welch: thank you, mr. chairman, mr. gowdy, mr. cummings, thank you for organizing this hearing. i think all of us should leave this hearing with some significant amount of humility. as i see it, the federal government primarily has to be a partner to the local communities that are doing all the front line work. when i look at what you've done here in baltimore, just the training of the number of people who are capable of
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administering lifesaving medication, the kind of all-in approach that the city has taken, and also johns hopkins has taken as well, our role as i see it is to try to get resources back to the communities so you can do your job because this appears to me fundamentally an issue that can only be addressed at the very local institutional individual level. sorry, dr. wen, about your 24-year-old patient was -- really says it all. i want to thank you and really, dr. alexander and mr. baum, thank you for your work. we're going to have a tough time in congress on money. you need more. and when we don't provide it our local first responders are put in a jam. our police officers. the hospitals. but we can do something about the cost of these drugs that have gone way up and it's my
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hope this committee -- there's been a lot of interest by many of our members on trying to take practical steps to maintain costs. mr. gowdy and mr. cummings have been part of this. what has this done to your budget, in your health department or in baltimore? -- en: we have redirected we redirected funds from other critical programs in order to fund this. so i have to choose all the time, do we fund asthma program for children, poisoning reduction or fund the opioid epidemic. mr. welch: i'll ask all of you, on these drugs like naloxone and others, have the changes that have been made largely in my view to extend splectual property protection and allow additional price increases, have they made a significant experience to the lifesaving quality to the patient or is it just the higher price? and you can all address that.
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dr. wen: hard to say except that, again, this is available in other countries for very little. and i would love to see us get the broad access this epidemic requires. mr. welch: mr. baum, is that an issue? mr. baum: i have met with all the manufacturers of these medications and talked to them about pricing. and they talked about how if you have insurance, either public or private, they have a very low co-payment. sometimes -- mr. welch: can i interrupt? i hear that all the time. it is so corrupt. i mean, what's the problem? i'm not directing this at you. i am directing it to them. what is the problem with being able to go on the internet and find out what it costs without obfuscation uted occurring in drug pricing? is it frustrating to you as it must be for -- mr. baum: i guess where i am, naloxone saves lives. we want everyone who needs
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access to it to get access to it. i was trained how to use it. i want it out available. mr. welch: what happens when the drug companies hold hostage your desire to save lives with a stickup price that bankrupts your operation? mr. baum: i think the story is more complicated than that. they are getting a lot of this product out at discounted prices. we need to continue to work with them and find resources to fund naloxone. mr. welch: explain to me why the price has gone up so much when it's basically the same product? mr. baum: i really -- i don't want to speak for the manufacturers but my understanding is they have a list price but the actual price at the retail level that is paid by consumers is -- r. welch: see, that's again is gobblygork. if you bought a car and paid $15,000 and the same car a year later is $25,000.
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you could figure it's a $10,000 difference. you can't figure that out now. mr. baum: we are keeping to get naloxone at a fair price. mr. welch: president trump said the pharma companies on pricing are getting away with murder. and by the way, all of us acknowledge that pharma does fantastic things. life-extending in pain-releaving drugs. if the price kills us, we're not really getting ahead. so we really need the president and all of us to get involved in trying to do legitimate things to contain this in my view price gouging. yield back. mr. gowdy: the gentleman from vermont yields back. i want to thank our panel. we have votes back in washington that they expect us to be there for, whether we want to be there or not, expect us to be there. i want to thank all three of you not only for your time and
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expertise but the dedication of your lives in helping other people and it's been very instructive i think for all the members. want to thank, again, the good folks at johns hopkins and the mayor and the governor, and governor christie. i want to thank you, mr. cummings, for being such a phenomenal host to all your colleagues. mr. cummings: again, i want to thank you, mr. chairman. you didn't have to do this but you did. and you made a commitment to me right after you became chairman that you were going to do this hearing and you kept your word and i really do appreciate that. to all of our witnesses and to johns hopkins, we thank you and to the members. i want to thank every member. people in the audience, this is a little bit of a sacrifice for members to come here. i know it's close to d.c. but they literally have to come in earlier than they normally would have. probably catch some earlier
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flights than they would have to be with us. i want to thank all of our members for being here. i just have one quick unanimous consent request, mr. chairman, and that is that the letter dated november 21, 2017, from the association for behavioral health and wellness be entered into the record. and that a testimony of the national health care for the homeless council be admitted into the record. and it's dated november 28, 2017. mr. gowdy: without objection. the gentleman from alabama looks like he seeks recognition. mr. palmer: we will have the opportunity to submit questions in writing? mr. gowdy: you may. let me get to that part of it. the hearing record will remain open for two weeks for any member to submit a written opening statement or questions for the record. if there are no further questions, no further business, we want to thank our second panel, again.
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particularly for your patience and that the first panel, super important but also went a little bit longer but we appreciate your patience and expertise and your comity with a t with the committee. with that we are adjourned. [applause] [captions copyright national cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit]
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>> president trump this morning tweeted, meeting with chuck and nancy today about keeping government open and working. problem is they want illegal immigrants flooding into our country unchecked, are weak on crime and want to substantially raise taxes. i don't see a deal. well, after that tweet, senate minority leader chuck schumer and house minority leader nancy pelosi cancelled a meeting with
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president. given the president doesn't see a deal, we believe the best path forward is continue negotiating with our republican counterparts in congress instead. then a statement from house speaker paul ryan and senate majority leader mitch mcconnell. while we have important work to do and democratic leaders have continually found new excuses not to meet with the administration to discuss these issues. there is a meeting at the white house this afternoon, and if democrats want to reach an agreement, they will be there. >> c-span, where history unfolds daily. in 1979, c-span was created as a public service by america's cable television companies and is brought to you today by your cable or satellite provider. >> at the white house yesterday, first lady melania trump previewed the white house christmas decorations and met with children participating


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