Cspan. The Senate HealthCommittee Last week held a hearing on the federal response to the nations opioid epidemic. Witnesses include National Institutes of Health DirectorFrancis Collins and food and Drug Administration commissioner scott gottlieb. The Senate Committee on health, education, labor, and pensions will please come to order. Todays hearing is about the Opioid Crisis we are facing and what the federal government is doing about it. Senator murray and i will each have an opening statement. Then well introduce the witnesses. After the witnesses testimony senators will each have five minutes of questions. The senate has inefficiently scheduled three votes starting now, and all of us would like to hear the witnesses testimony. So well figure out what to do about that. But best thing to do is go ahead and get started with our opening statements. The Opioid Crisis is tearing our communities apart, tearing families apart, and posing an enormous challenge to Health Care Providers and Law Enforcement officials. The amount of opioids prescribed in the United States in 2015 was enough for every american to be medicated around the clock for three weeks according to the centers for Disease Control and prevention n. 2016, there were over 7. 6 million opioid descriptions for pain in tn tn according to the Tennessee Department of health. That means there were 11,048 opioid prescriptions for every 1,000 persons. There was a study found that one in five pripd an additional ten days of opioids were found to be using opioids a year later. Last year 12 more died of an overdose than the year before, mostly due to an increase in overdoses of synthetic opioids, including fentanyl which is 100 times stronger than morphine and can kill with just a small dose. In blunt county, there were 2100 people to died decide in 2016 alone. Last year was the highest Overdose Deaths recorded in the history of our state. Three of four of the Overdose Deaths in tennessee were related to opioids. Last year over 1,000 babies in tennessee were born addicted to opioids. The rate of tennesseeans being prescribed opioids is one of the highest in the country. This is a crisis, not just in tennessee but acrosses the country. Since 1999, the rate of Overdose Deaths involving opioids including Prescription Drugs and heroin has nearly quadrupled in our nation. I hope todays distinguished panel of witnesses can give this committee an update on the federal response to the crisis, whats working, and what needs work. This committee has worked together to pass laws that help prevent addiction, encourage appropriate priping and improve treatment. In july 2016, the comprehensive addiction and recovery act, we call it kara was sign into law. This legislation established new programs and authorities, reauthorized existing ones, and encouraged Law Enforcement, Public Health departments and Health Care Providers to Work Together to combat Substance Abuse. A few weeks ago the administration announced that under kara, 144 million grants will be awarded to 58 recipients, including states, cities, health care organizations, tennessee will receive 6 million of that money. In december in 2016 as rt aft 21st century cures act we partnered to provide 1 million to treatment and prevents efforts. Gran the most ambitious goal of the 21st century cures was to drive the Research Discoveries predicted over the next decade by one of our Witnesses Today dr. Francis collins, the director of the National Institutes of health which he calls the national ininstitutes of health had. He has predicted the e. Do of an artificial pancreas, organs built from pishtr patient owes own stem sells. A vaccine and nonaddictive painkillers. None addictive ways to treat pain could be a medical device or different drugs. In 1928 what became known as the committee on the problems of drug dependens formed an organized research in pursuit of a nonaziktive painkiller. We all know the importance of finding a way to deal with pain. We were having a conversation just before the hearing. One report according to the New York Times says about a third of americans have intermittent pain. Dr. Collins says that 25 million americans live with pain every day. This is not to minimize the number of americans who need some form of help relieving pain. I want to hear today about the Public Private partnership that the National Institutes of health is leading and what about the policies that the fda has put in place to ensure that the opioid alternatives submitted to the fda are prioritized and get the attention they ought to. I have heard from numerous skps who either submitted to the fda or who have products for pain or development. And i want to make sure they have clear guidance on when the fda will review them in a tombly way. If traditional path wes do not fit these products i would like to hear how we can provide the help fda may need. Prescription monitoring programs, state run electronic databases that can help track prescribed entities are an important and innovative tool. Like forward to hearing today how we can help states integrate Prescription Drug monitoring programs with Electronic Health records to help inform physicians practices while protecting patient privacy. Congress has accomplished a hot in a bipartisan way to provide funding and update programs to assist states and help combat this Public Health crisis. I look forward to hearing how the administration is moving forward in this important work. Senator murray. Thank you very much chairman land land. And thank you to all of our colleagues for coming together for this truly urgent discussion. Every day from every corner of our country we hear more about the damage being caused by the Opioid Crisis. Lives being taken off track. Mothers and dads who worry about late night calls they might get or what it means if no call comes through. Children who have lost parents, communities, hospitals, Emergency Services overwhelmed. It is hard to grasp the full scope and scale of this crisis even as we learn more. I was recently in longview washington, a town in my state, visited a local hospital. He was told by the staff that nearly 5 of all babies born there last year have mothers who struggle with Substance Abuse. That was overwhelming and heart breaking. And it sfes to what ive heard from all over my state in every community from the big students, seattle he have wretd rhett, to smaller bellingham, spokane, tricities, vancouver, everywhere i go. In meetings hear the same thing with families and providers and patients and Law Enforcement professionals. This is not somebody elses problem. Its all of ours. Again, thats why im very glad that we have this opportunity today to discuss this and hear from leaders who are closest to those issues about what they are seeing and learning in each of their roles. So thank you all for joining us today. Im very glad you could all be here with us today. Though i have to say im very concerned dr. Fitzgerald has not sufficiently divested to be able to testify on such an important issue. We will be following up on that because we do need cdc be the at full strength and not subject to distractions that have been plaguing this administration. Now your agencies all play a critical role, and i know we are all looking forward to hearing how this administration is stepping up and where its falling behind. And that includes on implementation of the comprehensive addiction and recovery act, and the 21st century cures act. I will have specific questions for you afl you, including how sam is a is making sure federal funds are being used to help people in all off our communities. What steps cdc can take to prevent opioid misuse in the first place, how nih is working to support Biomedical Research that helps us better understand chronic pain and how fda is working to include Public Health considerations when it approves new pain products and assuring that nonaddictive pain products are being handled with clarity and consistency and an all hands on deck approach. I want to make a couple of pints at the outset. First of all todays hearing is only possible because the latest trump care bill met a deadend. It is a no brainer that undercutting the entirety of the countrys Health Care System would set us back in addressing this crisis. What we have seen from every repeal bill is drastic cuts to funding for treatment and addiction service, hits to medicate and critical patient protections that are today provided under current law. So i hope we can finally turn a page on those fights and focus on moving forward. And on that, i am, mr. Chairman, very appreciative of the bipartisanship that many of on this committee have shown in our ongoing work in the market stabilization. Another step is making sure we are doing everything we can right now to fight this crisis head on. And i do have several concerns. The administration has delayed critical steps that could help provide immediate relief to families suffering today. Proposing budget cuts for prevention efforts around Substance Use disorder and Mental Health programs under samsa, samsa undermining the value of treatment fortunately, we made some progress in this committee. Like everyone here im very proud to have worked on the 21st send true cures act which provided fun for treatment prevention and Recovery Efforts and the care act which provides outreach for skpreg postpartum women, and more. But i cant say clearly enough, our work is not over. And we must do more. As we work to build upon our work in kara and cures its absolutely critical we put investment into making sure these policies have the impact that families and communities need. We should be doing everything we can to tackle this crisis and push for actual results. Critical to that is that the administration is partner and not a hindrance to our efforts. We have a lot to cover today. Im look forward to our conversation. I know a lot of senates are juggling today votes and a Budget Hearing and other other hearings. I want to make sure we hear from senator sanders and anybody else before we move to questions. We will be glad to do that. Im going to offer brief introductions to our witnesses and hope we can hear from all four of them before i have to leave to go vote and then well see how we handling the three moats. Dr. Mccants cats is the assistant secretary for Mental Health and Substance Use, the lead agency. Samsa is the lead Agency Within the department of health and Human Services related to Substance Abuse and Mental Health. Dr. Debra howry, from the centers of Disease Control and prevention. Dr. Francis collins, and dr. Scott gottlieb, who is commissioner of the food and Drug Administration who was confirmed in may of this year. Dr. Mccants cats, why dont we begin with you and ask each of you to please summarize your comments in about five minutes. Thank you senator alexander. Chairman alexander, Ranking Member murray, else members of the committee, thank you for inviting me to testify at this important hearing. Im honored to testify along with my colleagues from the department of health and Human Services on the federal response to the Opioid Crisis. Over the past 15 years communities across our nation have been devastated by increasing prescription and elicit opioid abuse addiction and overdose. In 2016, over11 million americans misused prescription opioids, nearly 1 million used heroin, and 2. 1 million had an opioid use disorder due to prescription opioids use or heroin. Most alarming are the continued increases in deaths, especially the increase in deaths involving fentanyl and other highly potent opioids. The Trump Administration is committed to bringing bare on this health krcrisis. The department of health and Human Services have targeted five strategies. This comprehensive Evidence Base opioid strategy aims to improve access to treatment and Recovery Services to prevent the social, health and economic consequences associated with opioid addiction and to enable individuals to achieve long term recovery. To target the availability and distribution of overdose reversing drugs to ensure the broad provision of these drugs to people likely to experience an overdose. To strengthen Public Health data reporting and collection, to improve the limelinetimeliness specificity of data. Leads to the development of new treatments and identifies effective Public Health interventions to reduce opioid related health harms and to advance the practice of Pain Management to enable access to high quality evidenced base pain care that reduces the basis of pain for individual, families and societies while also reducing the inappropriate use of opioids and opioid related harms. Hhs appreciates congresss dedication to this issue as evidenced by the cures act. In my role as assistant secretary for Mental Health and Substance Use, i lead the Substance Abuse i appreciate the opportunity to share with you a portion of samhsas port fo portfolio. Samhsa is administering the opioid state targeted Response Grants Program created by the 21st century cures act by providing 485 million to states and fiscal year 2017, this program is increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and Recovery Services. Further were working to ensure the funding allocations and policies are as clinically sound, Evidence Based and official as they can be. For example, in the past four years more than 62,000 medical professionals have participated in online or inperson samhsa funded trainings on medication assisted treatment for opioid use disorders. Regulates treatment programs and provides waivers that provide for the treatment of opioid addiction. Last year samhsa published a ru ruler that to obtain a waiver to treat up 275 patients. As of september 19th, 3,573 physicians have done so. Allows Nurse Practitioners and physician assistants to prescribe. 275 Nurse Practitioners and 773 physician assistants have received a waiver from samhsa. Samhsa also promotes recovery from opioid and other Substance Use disorders through targeted grants of 4. 6 million over three years. To reverse overdose. Samhsa is currently providing grants to prevent opioid overdose related deaths which are being used to train First Responders. Last month samhsa awarded additional grants authorized by cara including almost 46 million over five years to grantees in 22 states to first responds as well as treatment providers who work directly with populations. States can also use opioid str grants and funds to purchase and some states are using a portion of their block grants. Samhsas National Survey employeds key level and data on a variety of Mental Health topics. Its a vital part of the surveillance effort related to opioids and the data has been used also works with other agencies to better understand the aepidemic through sharing o data. Thank you for the opportunity to share our work to com bot the opioid epidemic. For the information of senators, im going to stay through the four witnesses statements and then go vote. Will they hol the first vote . Im going to make sure i get there in time tod the first vote . Im going to make sure i get there in time to vote. If you want to stay through that we cant miss the first vote. Or you can fire me when im wrong. Doctor. Good morning, chairman alexander, Ranking Member murray and members of the committee. I am the doctor for prevention control. I was honored to join cdc three years ago to save even more lives in this role. I am pleased to have the opportunity to testify before you today. Cdcs