20 years. Weve been at this for a year and and a half or two years. It seems to me as a culture we need to learn patience. And not believing Silver Bullet answers. Like the mysteries of human pain. It is a complicated thing. Weve not solve this problem in the air and half or two years i would say of course not. We just need to keep working at it. These things exist because they took a long time for these things to exist. And Law Enforcement i would say, in general, some of the most innovative folks and innovative things i have seen come from Law Enforcement. We think not. Think Law Enforcement will be holding onto the old ways. No. Ive been amazed to see remarkably innovative ideas that come out of Law Enforcement. The one that you mentioned is one of them. One that i mentioned in my written testimony is about the transformation of jail. I believe if we come out of this with a new kind of jail, the new way that jail is run as you see actually in the state of kentucky, 2000 jails during the spring that would be an enormous advance. What is more jail would then be a asset again. Not a liability. Today jail is a liability. As a place we take people who, was a detox, want to see clearly the records of their own lives and want to change. Then we put them in a place that is tedious, predatory, ganged up, sexual stuff going on. All of that kind of spell only. And the pods that i have seen in seven jails and and one in particular in kentucky, a remarkable. A change of nurturing. One of time together. It is where youre working on recovery from the moment that you get up at eight in the morning and make your bed military style. Until 11 oclock or whenever lights go out. That kind of change in jail would be enormous. As a sediment testimony try to highlight things i thought would not just be beneficial to this problem but for the next drug problem as well. So its like playing whackamole with this stuff. I believe that jail in fact is one of the great places of effervescence you might say when it comes to the epidemic and the way new ideas are being tried. It is in jail and ive never spent but i think it what you are highlighting is one of those. I do believe it is an essential part of this. If we come out with jail the way we always have used it, then we will not really have advanced. And that is the problem that we will hit and we will wonder why we are not making greater advances. My feeling is changing jail is the way it is happening. Not just the revolutionary idea. You can find this in various examples around the country. It is very invigorating to see. Thank you. Thank you, senator collins. Senator casey. Thank you, mr. Chairman. Mr. Sam quinones, thank you for your testimony and i would like to start with some of the realities in a state like pennsylvania. We have had last year, 4624 Overdose Deaths. That is up 37 percent from the prior 2015. And rural areas are higher. Almost 10 Percentage Points higher byway percentage. Of an increase. And that is Overdose Deaths overall. Obviously love that being driven by the Opioid Crisis epidemic really. What i see and i miss some of the testimony going back and forth between hearings but what i see in pennsylvania is a tremendous resource. When we went across pennsylvania last year, especially this last summer, we would have meetings with county officials. Often in small Rural Counties. Smalltown counties where you have a group of people coming together. The mayor of a small town in the police chief in the corner. And any medical professionals that treatment professionals. All around the table meeting all the time every week. Because of the dead bodies that keep coming in. One county, a very small county said to us, maybe the most graphic metric was they did not have enough places to put bodies. That is how bad it was. It is everywhere but what i keep hearing from folks at the local level is we need more resources. We are getting our arms around this. We are dealing with this is a local community but we need more resources. They needed for Community Health workers, social workers, Law Enforcement. They obviously are bearing a lot of the third. I guess the first question i would ask is what recommendations we have for closing the resource gap which i think is a, in the federal government has made some strides as you know, with cures and what is your sense of the way the federal government can provide resources. Counties and the level of government most affected, corners, gels, libraries, public health, cherif, etc. I have been struck particularly in the last year year and and a half to watch the very organic taskforces, committees or what you have you. Sprout up in county after county. In pennsylvania, i was in i spoke with those folks at some length. Yes. These folks are coming together in very healthy ways. They are leveraging, theres a whole bunch of people on the committee. Our recovering addict, primary care doctors. I spoke with the president that recently she said one of the problems is we can find medical programming. For naloxone and whatever. But we cannot find money for the nuts and bolts that make it work. Like office space and you know that kind of stuff that as essential is not as sexy as the other stuff. To me, i think the federal government needs to step up. And the are wonderful but i do not think that we have been doing this for 20 years over prescribing and creating addiction unintentionally 20 years. One year, 1 billion is a lot of money. But in comparison to what the country needs comets in every state. It is an unprecedented problem because its in every state in america. Coasttocoast. This is, what i am suggesting is that this evidence shows that there is a need for sustained, i am talking years worth, sustained investment in i think, thinking in terms of for example, there is more mundane idea of how to, that their job easier. On telephones. That kind of thing. And we can talk later if you like about the issue of corners. But to me the crucial part of this as well. I think i know it feels like a lot of money, 1 billion is a lot of money. But not compared to the lack of depth and length of time that this problem aof this problem. It seems to me it needs to go. Thank you for that. I know we are out of time. I have done to commit for now billion a year. If the idea from the republican version of the repeal of aca where they were setting up a separate fund. So i just took what he thought was a good idea and made into a different bill. We are hoping that we can get support that will be bipartisan. We appreciate your testimony and your commitment to these issues. My pleasure. If you have any. Thank you can senator casey. Senator young. Mr. Sam quinones, thank you for being here and thank you for writing this book. You came to indiana to visit with us last week. I would like to discuss our children. Thousands of children across my state and really around the country are having our lives turned upside down. On account of this epidemic. Not because theyre addicts per se. But because they are being removed from their home. Their parents have become addicted. They are overwhelmed in an already overwhelmed foster care system. If identified in his book the need for more services for families. Can you elaborate on what specifically, what sort of needs there are for families or resources in your experience that might help mitigate this crisis. Well, i think honestly, as a reporter i like to say that probably the best to talk to people that work in that field. One of the areas that has been devastating is foster care. My goodness, theres so much need now. The word for grandparents in america today, it would be just, mind boggling to think with the needed b. Searcy, so many kids are living with their grandparents not because the mother and father are gone or in prison or what have you. So, my feeling on a very blunt basic kind of macrolevel that we need to look at, and how to fund more foster care. How to do foster care better is most likely another great question. But not one that i feel like i can answer. You know you are, your larger point about the solution, if you will to this order epidemic is, hundreds, thousands of individual solutions and collectively, many of them fall under the banner of community. Absolutely. If we can persuade individuals that a fellow human beings plight, a fellow childs hard luck is actually their own plight. Then we can entice more people to be foster parents. To care for these children. To lobby on their behalf and so forth. I think is a good overall message. Taking that away from your book. Weve already discussed the jails. In your book you have highlighted some gels that offer rehabilitation services. And particularly, in those areas, you have people putting themselves into the criminal Justice System just so they can get assistance. Or you have relatives or friends doing so. And i like to, i would like to sort of discuss a different sort of setting. I visited with jails. I used to represent the house of representatives, austin, indiana. You know that name because we have a huge hiv operation out there on account of the intravenous issues and nlp are named opana. Many communities like that around indiana have a strong suspicion because ive spoken with them. That their inmates have either hiv or hepatitis c or something else. That they might typically test for. They have a moral dilemma. There on the horns of a dilemma because if they test these individuals, there legally on the health to provide medical services to them. And in a place like scott county, indiana, that we deplete the entire Law Enforcement budget for a year if many of them tested positive. Look, im not asking you to be a magician here but, number one, have you encountered this dilemma and if yes, do you have any thoughts about how check request honestly senator, i have not. I do not doubt it exists. I mean nothing surprises me anymore about this topic i have to say. But i do not, and sandra do not you know, all i can say is that this is, it seems to be the nature of this problem that we are asking in one case, foster care. In another case that you just mentioned, a jailer to be the again, the magicians. To figure out this deep social problem and i do not think they have an answer for. They do not have an answer for this nor do they have the funding. What they go about doing sometimes, im a reporter. Sometimes i just have to say i mean, i dont know. Honestly, sometimes against the program overwhelmed by all of the ways that this problem manifests itself. There is a it is, i do believe locally, it is the place where we find the solutions. But that you all have an absolute role in facilitating. Making sure that they have the resources they need because on the ground i have to say, it the county, the people in the counties that i have been to our working hard and working imaginatively. And helping those solutions and facilitating the solutions. I agree. Senator bennett. I very much appreciate you having this hearing. One of the most compelling pieces of nonfiction ive read in a long, long time, and its very, very depressing. Something we havent really talked about which is the heroin epidemic that rode on the back of the prescription drug. Utility for lee and he. My reaction reading it is this was happening all in place but somehow we missed it. And today 42,000 people a year are dying from this. White house estimated that its costing the United States economy 504 billion a year comes wit, soa billion is a lott its. 2 of what its costing the economy. It isnt just about the Rural Counties anymore. The sheriff tells you a 92 of the people hes admitting our testing positive for heroin. The jailer that opens up and take us you back and opens up the window and says look what are you showing me . There are women in my jail. Ive never had women in my jail and we are spending. 2 on treatment, targeted treatment. So as a former local perso persm all about people in the local community but they cant do it without resources. If anything, they have less access today than they did ten years ago so it is striking we are moving in the wrong direction and i wonder whether you want to comment on that. One of the problems is with the overprescribing of the pills we created legions of addicts and that a weekend the vast logistics potential of the mexican Drug Trafficking culture which i know fairly well and that is when most never really cared to traffic heroine. Its viewed as a pretty disgusting drug and people are far more enamored with meth and coke and stuff, so they didnt really tragic heroine or they didnt really want to get involved in it too much until we began to explore and now the prophet motivation is at a very highlevel and thehigh level ant involved in that and it exploded on the numbers of people who are trafficking from mexico and so forth, so that is one thing. As i said before, i believe that the Community Solution is where it seems to me i have seen people working hard and coming up with solutions appropriate to their counties and their regions. I do not believe they can continue longterm without more help and sustained as ive seen a longterm focus from the federal government. I believe a lot of folks are looking to the federal Government Republican and democrat, rightwing and leftwing in this fight for the sustained health and not one off. You mentioned very briefly earlier about the ways in which healthinsurance reimbursement are creating challenges for the work level. Initially in Pain Management for many years Pain Management was to take one individual and design over a period of time ind close connection to the patient and doctor together a menu of strategies. Marital counseling, diet, acupuncture, things like that, physical therapy etc. As we began to believe that one kind of drug would be the solution to all the Insurance Companies dropped a lot of that and you couldnt design the full panoply. Because the were no longer getting reimbursed for a lot of that. To me i think it is fundamental in this whole problem. Doctors need to be more educated that when they get educated they need the tools and doctors were not told that there is a pain epidemic in the country and they were left with one tool. The reason we got into this. Ibb strongly and this comes from talking with lots of doctors about their dilemma is to find that they need more solutions in that moment when they are meeting in some places. Now they can get to the acupuncture etc. They are absolutely useful. It seems to me the reimbursement for printing strategies. Senator murkowski. Thank you for your leadership on this issue and really raising the level of awareness. As you pointed out, this has been out there for a while but i think my colleague just mentioned that its been growing in plain sight and thank you for acknowledging there is no one Silver Bullet. It is a complicated problem and yet we all know and have been mentioned its not just an adult problem. This is a problem that consumes all ages and spectrums and classes. Im interested in your suggestion that we need to look at this from a very Broad Perspective and really strive high on the Marshall Plan to follow the same lines of the space program. The problem i see with that is we are still suffocated and strangled by the stigma is attached. But is attached. It seems like it has just been recently that you will see in the obituary that there is an acknowledgment this young person, this individual died of an overdose. But we have very good because there is this sense of wide field as a parent if my kid died of a drug overdose. Until you can get beyond the stigma i think there are still so many like those are the ones who just couldnt take it. Those are failures, losers, which is a horrible thing to say and i even hate to say it in front of a microphone but there is the stigma that is out there. So how do we get people galvanized to help and to be inspired to do something as big as i agree with you that this needs to be in order to make the difference. That difference. Are we making headway in reducing the stigma . Guest crate question, thank you for asking. I think definitely we are. I was writing this book and i had a conversation with my wife i said we are going to write this book and put it out and fulfill a contract, but the truth is that is going to die when it comes out because nobody cares about this problem. I couldnt find anybody would want to talk about it except the occasional narcotics officer or judge. The reason was common one of the main reason most parents or families were mortified, and barest. This is a different kind of problem and people were mortified at what had happened to their children. You never saw an obituary that told the truth. It was like he issue. In this case it was he died at home of a heart attack at age 25. Now, i believe that what is hoping to change that i think similar to say the marriage issue it is getting to know people that are affected. I know youve heard a lot about how you need to provide more funding but i do believe we have a public profile role. If you go to the communities and find those parents, talk to them, meet with the county groups that are sprouting up all over the country. Its amazing to see this and when your own high public profile meets with parents and say thank you, tell us your story and helped recruit them. I think that theres a lot of folks who would go along and do that if they were asked. If they were flooded with, please do this. And as i said maybe it is because i am a reporter but i agree with the power of the story teaching peoples minds. As human beings from the prehistoric times to today weve always needed stories to help us understand and the reason this wasnt very wellpublicized is because the people who could best tell the story didnt and now increasingly they want to talk and its so important to embrace them and bring them out of the shadows they wanted many of them not yet but others someday soon and with that my feeling is theres a horrible stigma exactly as you say and one of the main ways we defeat that is through stories and i believe as Public Officials, you all have a magnificent old whenever you go home or go to some public event that may deal with this, find those parents com,bring them out, have them tk about it, and recruit them to give them a phone call saying i heard this happen and we would love to hear