And i believe senator durbin has some opening remarks. We will dive into the witness testimony as well. 1999, more than 700,000 people have died from a Drug Overdose in the United States. Increased opioid addiction in the production of deadly synthetic opioids has exasperated americans staggering overdose death rates. Than 70,000 people died from Drug Overdoses, making it the leading cause of injury related death in the United States. Of those, 68 involved prescription opioids and illicit opioids such as fentanyl. Americans fared no better against the epidemic in 2018 when more than 10 Million People aged 12 or older abused opioids. 2 Million People suffered from an opioid use disorder, and on average 130 americans tied each day from an opioid overdose. Cost and know the disrupted lives and untimely deaths from widespread misuse of prescription and nonprescription opioids. We know from our family, our neighbors and our friends who bear the enduring imprint of lost love ones that the Opioid Crisis is not over. We must continue contending with this crisis. That being said, we have made Great Strides in the past three years to help combat this crippling epidemic. Congress has passed and mark Bipartisan Legislation directed at combating the crisis. Most notably the conference of the dictionary recovery act, and the 21st century cure act, both of which i proudly supported and were signed into law in 2016. Probably supported and signed into law in 2016. Combined, the two bills provided over 1 billion in funding to combat the Opioid Crisis. Later, Congress Passed the bipartisan support for communities act, which is the most comprehensive antiDrug Trafficking act in modern history. To addressthe act every element from manufacturers to distributors to prescribers, dispensers, users, First Responders, and recovery professionals. Nearlys has dedicated 11 billion to tackle the Opioid Crisis with the largest portions about funding grants to the department of health and Human Services. Today we will hear from the administration and the executive Branch Members that shape and execute the governments strategy for combating the Opioid Epidemic. National drug control policy, the department of justice, the Drug Enforcement administration, and the department of health and Human Services. This hearing is especially important when we think about the oversight role we have in congress to ensure the executive Branch Partners are properly stewarding of the funding we have provided to them to clearly tackle the Opioid Crisis. The federal government is just one aspect of combating this epidemic. We do not stand alone. Opioid crisis relies on widescale integrated solutions on all impacted sectors. Today during the hearing, we will also have the opportunity to hear from key components and including the health care abuse alliance, community antidrug coalitions of america, and drug policy experts from the rand corporation. Comprehensive review of our collective efforts to curb the supply of illicit opioids to improve access for preventativebased treatment and Recovery Services for opioid use disorder, to identify needs at federal, state, and local level, and to develop sophisticated and catered solutions to this destructive and deadly crisis. I would like to take a moment to remind us all the americas drug abuse problem did not begin with opioid misuse and will not end with the Opioid Crisis. In my home state of iowa, methamphetamine abuse has remained a persistent and perilous problem. Almost one Million People had a methamphetamine use disorder, and they reportedly had significant impairment including health problems, disabilities, and failures to meet responsibly it is at work, school, or home as a result of their drug use. This number is significantly higher than the 684,000 people who reported having methamphetamine use disorder in 2016. Confirmedy home state over 1500 child abuse report related to methamphetamine, not just in the home but being found in the childs body. Ultimately americans are suffering from drug dependency. Dying at ones are alarming rates. Todays are our priority but methamphetamine and other dangerous substances impacting urban and Rural Communities should and will be addressed Going Forward for thank you and now i will turn to Ranking Member feinstein for her Opening Statement. Feinstein i think our Opening Statements dovetail each other and i suspect they dovetail what every member of the committee thinks. The question is what to do about it. Werelast year, overdoses creating of 48,000 dabs. Deaths, and 2016, Life Expectancy in the u. S. Has fallen for the third year largely due to opioidrelated overdose dabs. Arethe economic costs unbelievable. 700 billion a year. Lackf the reasons is the of education among medical professionals. Overprescribing and so we saw in many cases, pharmacies were pill mills with churning out millions of pills to smaller communities. Regardless of medical intensity. Opioid manufacturers and astributors, i believe, have responsibility to identify and report the suspicious orders. But they did not. This problem was compounded by inadequate responses from the federal, the state, and local governments. The Trump Administration declared the Opioid Epidemic a 2017c Health Emergency and has only used 3 three of the seven authorities triggered by that declaration, limiting its effects. To issue failed National Drug control strategies in 2017 and 2018. 2019 its 2019 strategy did not include fiveyear goals or projection for Program Budget priorities, both of which are required by law. 2019ding to the october department of justice ig report, the Justice Department and dea did not initially use all of the resources and authorities. Reduced quotas for opioids or hold registrants adequately accountable. The result was an Opioid Epidemic that evolved from Prescription Drugs to heroin and fentanyl. , to there is little question in my mind that the initial response to the opioid situation was ineffective. How do we get back on track . I very much believe that any solution must include a whole of government approach and we have to use all available resources. The comprehensive addiction and recovery act enacted in 2016 laid the foundation for this approach. , the support act, was signed into law last year. The 2016 legislation by authorizing critical agencies as well as prevention, treatment, recovery, and resource programs. Included aso provision called the using data to prevent opioid diversion. This part of the law is designed to ensure that opioid manufacturers and distributors are held criminally and civilly liable for identifying and reporting suspicious orders of opioids. I happen to be the one that authored that, and i am very much concerned that it is never been enforced. Today, i am introducing new legislation to strengthen this law. This legislation will require data on all controlled substances to be reported, not just opioids. In order to better identify suspicious orders. It will require pharmacies to report all transfers of controlled substances to the dea each month. There is so much to do. The federal government has begun to do this. P has established a number of interagency working groups including the National OpioidCoordination Group to monitor trends and data. The Justice Department created the opioid enforcement efforts and division and that is a opioid fraud and abuse detection unit under a new initiative focused onode, disrupting the online sale of illicit drugs. For its part, dea has increased its tactical diversion squad, enforcement, and administrative actions against negligent distributors and manufacturers. Efforts,lt of these for the First Time Since 1990, Prescription Drug related Overdose Deaths decreased. That is really good news. So there are things that we can do to save life and reduce addiction. Centers for Disease Control and prevention has warned us for wave of drug epidemics is upon us. Most suffering from addiction they tell us use more than just opioids. In 2018, methamphetamine, benzodiazepines was opioidt in 60 of all overdose related deaths. That is a stunning figure to me. We have to take a look at it and see what we need to do. I would encourage our Witnesses Today to comment on this, and if you have a solution or thought, we would be very interested in hearing them. Our country has been ravaged by an addiction epidemic, and it costs tens of thousands of lives every year. Failure should not be an option. This is an important hearing and i so look forward to hearing from our witnesses hopefully with new ideas and constructive thoughts. Thank you, madam chairman. I recognize senator durbin for opening comments. Sen. Durbin thank you for this hearing and i called senator graham several weeks ago and asked him to consider this, and i think him and to you for making this possible. I will not state what has already been stated. Thean accept that we are in worst drug epidemic in history of the u. S. , losing an average 201717, an average in of 138 people a day. There is no town too small to escape this drug epidemic in my state and across the nation. It is not the first drug epidemic in our history. The crack cocaine epidemic showed and i hope that we learned we cannot incarcerate our way out of the addiction crisis. We need prevention, intervention, and treatment on the front end and not just prosecution on the backend. There is a growing bipartisan consensus that harsh prison sentences have not only failed to stop drug addiction but have created many unjust and disastrous outcomes. Communitythat this spearheaded the action of the First Step Act to right these wrongs. Now as we combat current drugs on the market and the spread of synthetic fentanyl analogs that we do not impede Scientific Research that can save people to overdose on these drugs and that we do not criminalize substances in the process. Let me ask you if you have consider just this fact. A recent study of fentanyl overdoses in massachusetts in 2014 to 2016 found 83 of patients required more than two naloxone doses. Why . Because naloxone no longer is Strong Enough to stop an overdose. Many researchers believe a more powerful antidote make include the drug fentanyl or some analog. That is why i am proposing legislation that will allow the truly harmful analogs to be added to schedule 1, but not at the expense of facilitating Viral Research for facilitating antidotes. There has been an effort to bypass this conversation about the research aspects. I hope we can return to it. We can learn an important lesson from the 1998 tobacco master settlement agreement. Was a landmark to hold big tobacco responsible for hooking americans on nicotine and contributing to millions of deaths. I might add, they are added again with vaping. Only 8 of the dollars paid under that settlement were devoted to Public Health harms of nicotine addiction. Most of the money was spent on unrelated items like roads, stadiums. Many states, cities, and counties have sued the opioid industry and there is a massive lawsuit underway in cleveland today that could produce a large settlement. It is critical that a substantial portion of the settlement to be dedicated to fighting opioid addiction. It was in june 2016 in this hearing room at this very table the i learned for first time that the acting director of the Drug Enforcement administration revealed on the record that it was actually the dea that approved the annual quota of opioids to be produced in the United States. Opioid addiction starts with prescription painkillers made by pharmaceutical companies, regulated by the Drug Enforcement administration. The Inspector General of the department of justice dea was slow to respond to the dramatic increase in opioid abuse and needs to more fully utilize its Regulatory Authority and resources. For years, dea permitted pharma to produce enormous, evergrowing amount of opioid pills each year. Abilityugh dea had the to set quotas limiting that production. For example, in 2017, the Drug Enforcement administration of the United States of america allowed pharma to produce 13 billion opioid doses to be put on the market. How much would that be . It would be a three week prescription for every adult in america approved by the Drug Enforcement administration. For years, ive been calling on them to set lower quotas. Last year, senator kennedy of louisiana on the others and i joined in a bipartisan effort to reform a law and required the dea to adjust opioid quotas to reflect the reality of what is happening in america. Madam chair, i am sure you are well aware of accounting in your state that is on the border of iowa and illinois. 45 county, iowa averaged opioid pills per person for nearly a decade, dispensed by one pharmacy in that county. 45 opioid pills per person for every person living in that county for 10 years. In harden county, illinois, one of the least populated counties in my state, 4300 people, but between 2006 and 2012, enough opioids to provide every resident with 90 painkiller pills a year. The dea is supposed to monitor this. They are proving massive production on the front end, and no monitoring on the backend. As we see these areas, Rural Counties being swamped with opioids. For years, we have been calling on them to lower quotas and now they have the legislative authority and the no excuses. I am concerned the dea is not taking it as seriously as it should and i will ask questions we reach that point. While the dea has lowered the indefensible opioid quotas in recent years, the proposed 2020 quotas do not take into account drug addiction, overdoses, and death. In other words, the pharma production quotas do not look at the reality of the worst drug epidemic going on in america today. Withk forward to working my colleagues to continuing on a bipartisan basis to deal with this. Ourow we will start with panel 1. We will introduce our witnesses and then we will start with witness statements. With us today on panel 1, we chester, the assistant director of National Opioids and synthetics Coordination Group of the office of National Drug control policy. Capacity, mr. Chester leads interagency efforts to reduce the availability of , andn, fentanyl synthetic drugs in the u. S. By disrupting the supply chain. And shemiss lipscomb, is responsible for coordinating the departments strategic responses to the Opioid Crisis including all investigative and prosecutorial efforts. We also have mr. William mcdermott. Mr. Mcdermott was appointed as the assistant administrator to deas diversions control division. He serves as the principal advisor to the administrator on all matters relating to and listed, chemicals. Niraj, serving as the chief medical officer of Substance Abuse and Mental Health services. He is familiar with the development and utilization of medical services, budgets, nuances, regulations and code across states and provides perspective as he delivers care. Thank you for being with us. We will start with our witness statements and we will start with you mr. Chester. Ernstester chairwoman and members of the committee, thank you for inviting me to testify in the illicit opioid environment we continue to face in the United States and the government approach to addressing it. The office of National Drug control policy under the leadership of jim carroll is uniquely under the office of the president. Began work, the dominant drug was heroin. Nonintravenous use and heroin enabled an easy transition for prescription opioids to elicit opioids. An overdoserged as driver in 2015. By 2017, many states experienced a crossover were more people were overdosing and dying from fentanyl than heroin exclusively. Today we see even more diversification across the opioid environment with the variety of fentanyl and nonfentanyl. Pills sold onnto the darknet and delivered directly to consumers. Complicated by user transference of different typesypes and not opioid like methamphetamine. By president ial leadership, strong bipartisan support in congress,