The committee will please come to order. We turn our attention to the opiate crisis. The nations number one Public Health challenge. Our witnesses sam, the author dream and, true to of americas opiate epidemic. Senator moran i will have an opening statement. Though will hear from our witness. Ive suggested if he wants to take more than five minutes to say what he has to say we would welcome that. Theres plenty of conversation back and forth it is unusual to have a single witness utter hearing. This is an unusual topic. One you quote gary franken is the worst madman epidemic in history. The challenge it presents has captured the attention of every member. This is what we call the bipartisan hearing. Most wars are. Democrats and republicans have agreed on the topic, on its importance in the witness. Its my hope that will restrain from lecturing one another and Health Insurance and focus on the topic. This kills more americans every day than car accidents. In each state were reminded of that almost every day. Yesterday a job i am meeting in nashville, the head of all of our state institutions with training doctors the governor told me in our state of 6. 6 Million People there are 7. 6 million opiate prescriptions written. Even though the state has reduced amounts of opiates prescribed, the number of Overdose Deaths was up because of the sentinel. Rather than spending more time on the crisis i wanna learn from you. When 100 million americans live with pain 25 million with chronic or severe pain why is it not a good idea to find the holy grail of medicine, nonaddictive Pain Medicine . Stronger communities are the ultimate solution work in a Central Government washing can washington do that helps . Do you have a chapter entitled searching for the holy grail. I read your book. I think theyre a number of others weve about it with them. The search began 75 years ago and 28 with the committee on problems with drug dependence. Couldnt the best scientists find a way to extract painkilling elements from morphing while discarding his miserable addictiveness . This effort to find a better way to treat pain to revolution toward pain treatment. First the pain of dying patients then chronic pain and pain clinics, and enterprising drug company spiraling into the addiction and consequences we find today. At least twice doctor Francis Collins had predicted the holy grail that was for so is now within reach. Last month he said perhaps within five years. His organize nih researchers with private companies to speed up the process. Doctor Scott Gottlieb is on track to fasttrack it. I read at least some of your book to say that some of this may never be found. Some scientists it should not be found. I hope you will tell us what you think. Should we not continue to find nonaddictive Pain Medicine ten suffering . The secondary i want to learn is what we can do from washington, d. C. Weve tried to address the ravages of this. Congress passed the comprehensive Addiction Recovery act of the 21st century cares hacked to give states and communities the tools and resources they need to combat the crisis. Theres a provision by senators warning capital that made it clear pharmacies could only fill part of certain prescriptions that way a mob filling the pain prescription could ask only for three days worth of pills instead of 30 days he was prescribed. In addition it included for the 1 billion in state grants. Were considering additional funding for treatment and to discover alternative Pain Medicines. Weve held hearings on Lifestyle Changes such as exercising and eating healthier. You and i apparently have one thing in common. Im a skeptic of washin you s is a problem of society. What a loser sense of community we become easy prey for external solutions to complex problems like opiates. In your words quote i believe more strongly the antidote is community. Make sure people do things together. Break down barriers to keep people isolated and Strong Families where everyone is interested in the wellbeing of everybody else. Whenever ive tried to solve a problem in the end its boil down to creating an environment in which create communities to create problems. For example after spending years in state reform in education i traveled the state to create 143rd better schools taskforces. I have the same views as a fixed child left behind so, what does congress do from kin washington, d. C. About this opiate crisis . We have jurisdiction over a significant amount of what youve written about a dreamland but not the spending of money. Were eager to hear your testimony in your solutions. I am glad to be continuing our discussion on this important issue. Our witness today has been following the crisis and growth and thank you for joining us. I also welcome your wife and daughter who i assume are sitting behind you there. I look forward to hearing your perspective on how to better help support this crisis. I appreciate the investigator work that you have done to shed light on this challenge. The rising this is broader in scope than any book can tell. This people from every background and corner of the country that has stories about the harm this is done. These are veterans think chronic pain struggling with addiction, doctors cheatin treating babiesd and more. Ive heard the stories firsthand the meeting with doctors and families fighting this disease. Visiting a local hospital the staff told me almost one out of every two babies born have mothers who struggle with Substance Abuse. Thats astonishing and heartbreaking. Its not the only evidence of this epidemic. This is much is happening in longview, local hospitals across the nation. Were losing 91 people a day to opiate overdose. I dont just mean the individuals facing theres other victims as well. Children struggling to cope with the impact of their parents addiction. Many of foster homes. Parents were shattered with the heartbreak of their childs illness and many struggling with the financial cost and it hurts our communities as a whole. It takes up resources, it takes workers out of our local economy. We are behind the curve of fighting the sect but. One was a state employee a woman named jamie mae. A pharmacist charged with overseeing the cases who are receiving Prescription Drug from injuries. She noticed summertime from the same painkillers that been prescribed. The paper she published in 2005 was one of the first papers in the country. She published her paper over a decade ago which shows we have been fighting this battle far too long. Im glad weve taken the necessary steps. In 2016 it passed the cares hacked which included a billion dollars in states the comprehensive addiction and recovery act which supports specific outreach for veterans and postpartum women. There is more to do. Along with many my colleagues i hope we can move more funding in the budget or appropriations agreement. First responders and Treatment Professionals have made it clear that continued federal funding is key. Fortunately weve heard talk but weve yet to see the president take the action that this emergency to mans and that he promised families. The own council of economic advisers estimated the expert Economic Cost to be over 500 billion just for 2015. Addressing the problem the spec will take an enormous investment of time and energy focus im eager to see this committee continue the bipartisan approach to take action to address this epidemic. I look forward to working with you in heaven are members bring their ideas forward. We have to do more to fund the prevention efforts and treatment programs. It means providing supplemental states needs to implement tools to help turn the epidemic around. We need to learn i know the people on the ground have the resources they need to respond. It means going beyond treatment and recovery. We need to support the individuals in the families and communities suffering. Im interested to hear your perspective. Im grateful for you being here today. Before going to beat this, we have to find and interact solutions. I look forward to working with you and the members. Thank you for having an important hearing. Thank you for taking the time to be here. If 30 Years Experience as a journalist and author. Written extensively on truck trafficking. The other three claim books, the most recent book one a National Book critics circle award. Early in the career he was the recipient of the maria moores cabinet price. The oldest International Word in journalism covering latin america. The recipient of a patterson fellowship awarded to print journalists. Welcome. Clearly im a rookie here. When a thank you for having us hearing allowing me the opportunity to address it. Im happy to be here with my wife and daughter were part of producing dreamland and without whom the book not have been finished. This is the deadliest drug that we have known hitting areas that have never seen this drug problem. The first in modern america to be spread not by mafias or street dealers but by doctors over prescribing pain pills convince theyre doing right. Urged on by the pharmaceutical industry the medical establishment and urged on by us, the American Health consumers who want an easy end to pain. Isis could not have changed of inciting the kind of torment and death we have upon ourselves. These drugs are symbol for our era. Formals for decades weve exulted the private sector while we ridiculed government as inefficient, incompetent and wasteful. We admire wealthy Business People regardless of the way they made their money produce value to our country and communities. We have a second gilded age. This epidemic that tries on a the costs have been borne by the Public Sector all the has been private. I believe its about issues far deeper. The effect of the cultural shift about the hollowing out of smalltown america and the middle class and that buying stuff that they could be attacks with one magical Silver Bullet. In so doing we put ourselves of doing things so essential that they have no price. We have been invaded by cheap junk as a result. We dug up dreamland pool replaced it with the stripmall. Heroin is what you get when you destroy dreamland. Isolationists parents natural habitat. The epidemic is calling on us to come together. I believe more strongly than ever the antidote to hear what is not in it is community. People coming together to work in small and local ways for solution. No one saving the world alone. The good news is there is no solution. Theres Many Solutions, each small and must be tinkered with. Some discarded and each must be funded fully in for a long time. None of them is sexy. None will do the trick alone. Across america communities are finding the solutions. The more they leverage the talent and energy bringing in ptas, pastors, recovering addicts and librarians in the chamber of commerce, the more cops and Public Health nurses who bridge the cultural kata schism between them. We did not have this demand into terry had a large supply of narcotics in the last two decades. I believe doctors reassess how, to whom and in what quantity they prescribe the drugs. That does not mean cutting people off who are on high doses of the trunk and leaving them to fight for themselves. Means allowing Insurance Companies that do not involve narcotics. Allowing a wider away ray of pain strategies. Young docs need more education that school and Pain Management and addiction treatment. Its delusionals to spend time and money on yet another wall along the border hoping this will stanch the supply of heroin and fentanyl. Drugs are coming in with areas already. The only thing that will truly help stop these trucks into our country is a deep respectful and forthright and honest relationship with mexico that will lead to becoming a neighboring partner we can work with effectively. Another wall is just like carolyn. It feels good for the moment but will leave us in the worst place in the long run. Another Silver Bullet for complicated adult problem. Sometimes its about the monday mechanics of governing. We should find new ways to expand our National Forest of pathologist which is dangerously dwindling. We must expand Treatment Options in the country. One place to do it is jail. Consider how the country will be help by transforming jail into a place of nurturing recovery instead of tedium. It becomes an asset instead of the liability. I would also add that all across America Family suffering due to the addiction of a loved one or the loss of a loved one. They are the raw material to be marshaled and harnessed in this fight. Many need to be involved to help solve the wounds that will last a lifetime. Senators can help this by recognizing and giving platforms to which to tell their story. Maybe because im a reporter, i believe the stories of addiction can be reduced. Im happy to elaborate on any of this. Want to urge you to view this as an opportunity to revive the regions him or by globalization and free trade. The roots of our narcotic addiction stands in the way of revival. Many regions cannot revive until people can pass a drug test of fill new jobs. This is not only a story of drug addiction but of economic affliction. Has politicians who natural response is to look for things you can do quickly to show constituents are taking action. Thats understandable i would caution against believing in shortterm actions. Carol makes up a great start but its only a start. Everything ever learned has taught me the importance of longterm Community Responses and commitment. American history offers two templates for action first is the Marshall Plan to rebuild europe after world war ii. The second is our Space Program. Each of of government and the private sector bring in money, brains, energy and longterm focus. Each achieved a good for country. You were doing things are be on her own shortterm selfinterest. The Marshall Plan was about building up ravaged regions while containing the viral spread of soviet communism. It allowed report countries to prosper and contribute to the world again. A Marshall Plan for american recovery might focus on rebuilding the regions caught and ravaged by economic devastation to contain the viral spread of addiction. To our Space Program we are inspired to spend years of dollars to achieve something no previous generation ever thought possible. We ended up far beyond the moon. To spill over benefit, and simple human that is beyond calculation. Seems to me we might profitably apply these examples. To regions of forgot americans for the problem began. Listed not because its easy but because it is hard. Because thats what americans do and has always done. Like our Space Program i believe an effort will need to last for years to be a folk effective. Focus on the profound problems of destruction in the hollowing out of the country. But also as a gift that it can be. Its an opportunity to bridge the polarization that not that the country. One of the few issues that can do that. Do not miss the opportunity. It doesnt come around often. This calling is the very reason you got here in the first place. Youll be remembered for acting when acting was not easy to do. I believe your hometowns will thank you. Your county will thank you. And we, your countrymen and women will thank you long after youre gone. Im happy to talk about anything you want. We will have a fiveminute round of questions. Ill try to stick to five minutes because we have senators who want test questions. The book was great not sure i can see copies around the desk. Its a hundred yards long you can see how the community was surrounding the pool and activities. The idea that big pharma lighting committed fraud is a part of the book and part of the problem. Theyre punished but we need to make sure people cannot. Some of it could be state law. I continue to become more more alarmed that our profession is part of the problem. Weve tried to fix it. We monitor and see if theyre seeking different doctors we have gotten rid of bad doctors, the pill mills are no longer in kentucky. Yet, we have a county in the mountains of 21000 people. Last year 2. 8 million dose of hydrocodone. Everybody knows its a problem. And it was worse last year. They prescribe more. Its an 11 increase. When we look at what we do we have to think about how we spend it and what we do. We want people to have healthcare so weeks been medicaid. You can have an overlay of the hair when an opiate problem is related to poverty and healthcare expansion. Pay 3 a month and you can get it trade it. We have to figure out more rules. The hard part is the chronic. If im your physician and you been coming to me for low back pain that i get you off of it . We all know the knowledge. People have read your book and yet we still have this enormous prescription opiate problem i agree how do we fix the medical aspect of it. Thats a massive question i think one of the reasons you find a correlation between heroin overdose the Medicaid Expansion is because more access to medical care means more access to pills. We havent change the basic culture. One of the reasons for doctors to prescribe pills for if we get back to the 1970s Insurance Companies were reimbursing a wide array of strategies for pain. Cut back significantly in many areas. It gets back to the dr. Has available to him or her to me that feels like a crucial step. I run into doctors who tell me that say they dont have other options. I live in a county with 4 unemployment. Players, say we cant find enough workers that are drugfree. Then 30 of the people at work 30