The National Institute on drug abuse. This is two hours and 15 minutes. Good morning. Welcome to this hearing called fentanyl the next wave of the Opioid Crisis. America is in a full on Opioid Crisis. It started with the overprescribing of opioid drugs and then shifted more to heroin. Today, the subcommittee examines the next wave of the Opioid Crisis and fentanyl. Fentanyl is made in the lab and for many years, it has been a powerful pain medication used by patients with cancer or for those with extreme pain. When i was injured in iraq a few years ago, Battlefield Medicine they, and recovery, gave me lots of fentanyl patches. It is 50 times more potent than heroine and 100 times more potent than morphine. Now, fentanyl has been a powerful additive. This is the way the drug dealers increase profits and expand the number of addicts, by juicing the potency of heroine or other street drugs, like people have done with msg in foods. Users often do not know that fentanyl is in the heroine. The fentanyl crisis is exceptionally dangerous because of its high potency and the speed with which it reaches the brain. Two milligrams of fentanyl can kill. To appreciate how small an amount of two milligrams, a at ecier packet here your restaurant table is 1000 milligrams. You see at your restaurant table is 1000 milligrams. It may require higher doses and multiple administrations of mo brooks on to reverse the overdose and to become stabilized. Even the police and First Responders are at risk from inadvertently touching or inhaling fentanyl powder at a crime scene or helping an overdose victim. In march 2015, the Drug Enforcement administration or dea issued a nationwide alert on fentanyl as a threat. A year later, the dea sent it anr alert calling unprecedented threat. Customs and Border Protection data shows and 83 fold increase andhe amount of fentanyl she is in three years. There are many chemical variations of fentanyl commonly referred to as analogs. There are 30 known analogues however only 19 of these analogs are controlled substances under federal law. Since 2013, overdoses and deaths have surged with no end in sight. Fentanyl and its an all caps intruded into at least 5000 Overdose Deaths in the United States including the death of music star prince asked year. Last year, 86 people in west county died from Drug Overdoses linked to fentanyl. Statistics seriously undercut the fentanyl threat nationally because most states and counties are not testing or tracking fentanyl in Drug Overdose cases. So we are flying blind. Of Law Enforcement and the healthcare care system will be overwhelmed. China is the primary source of fentanyl and there are thousands making illicit cure for general as pickers is needed to manufacture fentanyl. Traffickers shift these ingredients to secret labs in mexico run by drug cartels and smuggle pounds of fentanyl over the southwest quarter through our porous borders, launching it through catapults or drones. Into the u. S. Chinese labs are also a primary source for fentanyl ordered on the open internet and only dark web. Your fentanyl mail or express is ordered through carriers. Finally, china is the main source of pill processors that can make thousands a pill in our support fentanyl operations. Im pleased to add that china is saying they are taking some actions to reduce this and we look forward to working with them because it is so deadly. The fentanyl problem is spreading and going to get worse because the money and profit is enormous. According to the data from dea a kilogram of color and can be a kilogram of heroine can be purchased for roughly 6000 and sold hotel for 80,000. However a kilogram of pure , fennel can be purchased for less than 5000 and is so potent that it can be stretched into using cutting agents as talcum powder or caffeine. Therefore, while the each kilogram can be sold wholesale for 80,000, it can result in a total profit of the neighborhood of 1. 6 million. Thats about 20 times more profit. We need a federal strategy dedicated to combat and fennel fentanyl as the clear and present danger that it presents for National Security and Public Health. We welcome our panel of witnesses today. We salute you for your work. Thank you for appearing today , and i look forward to working together to stop the spread of this epidemic. I recognize my friend from tte. Rado, miss dege thank you, chairman. Ms. Degette every day somewhere in this country there is an account about how opiate addiction has wracked a small town or family. Personal stories about americans who become addicted to pain pills and then they get hooked on heroin. These are heartbreaking stories about americans dying and leaving loved ones. Often their children to pick up the pieces. The Opioid Epidemic is unprecedented and it is escalating and i think we all agree that we need a copy of the strategy to confront it. In 2015, more than 33000 americans died of an overdose involving a prescription or illicit opioid and more than 2 Million People had an opioid use disorder. It adds an Even Deadlier layer to this crisis. It can be up to 50 times more potent than heroine, and 100 times more potent than morphine. Lethal at even the tiniest amounts and anyone , exposed to it can have it detrimental. Illicit fentanyl is not a new problem. What is new is its growing prevalence. Since 2010, fentanyl recovered by american Law Enforcement nationwide has risen 20 fold from 640 samples tested to 13000 samples tested in 2015, according to information from the dea. U. S. Law enforcement, as the chairman said believes china is , the primary source of illicit fentanyl and precursor chemicals. Producers shipped fentanyl and chemicals to make it directly into the United States. Precursor chemicals or finished fentanyl, is shipped to mexico and canada where traffic across our border in pure form or mixed with other illicit drug like heroine. Today we want want to ask the , panel some tough questions about Law Enforcement and diplomatic efforts to extend stem the tide of fentanyl flowing from china and whether they are sufficient. We are also going to ask which vectors drug traffickers use to ship this drug into our country like express consignment care is carriers and International Mail. I think this is another important step that the Second Committee has taken to address the Opioid Epidemic and for the record, i want to to continue this bipartisan work. That said, mr. Chairman i also , think we need to find a way to address the treatments that this treatment side of this epidemic, and this is sadly where i have significant differences with my majority colleagues. Passage of the Affordable Care act, as you know has led to , nearly 20 million americans gaining health care coverage. In addition, the aca has been able to governors to expand the Medicaid Services they offer, which was critical in states that were overwhelmed by the Opioid Epidemic. Studies estimate that since 2014, 1. 6 million uninsured americans gained access to Substance Abuse treatment across the 31 states, like mine, when expanded medicaid coverage. This is particularly important for hardhit states like kentucky where one Study Reports , that residents saw 700 increase in medicaid beneficiary ies seeking treatment for Substance Abuse. Two weeks ago, the majority rushed through this committee a bill to repeal the aca that many believe will threaten the progress that Medicaid Expansion has made in getting people suffering from addiction and to treatment. In its assessment of that bill last week, Congressional Budget Office said that millions of americans, 24 million of them, will lose health coverage. Many of those will be people currently receiving medicaid assistance, which includes people receiving treatment for opiate addiction. In january, healthcare aspects experts from harvard and then why you wrote an oped for the hill about how repealing the aca would reverse important Public Health gains. They focused primarily on my baby, the 21st century care act which i did with fred upton, and all of this whole committee. Thatprove it unanimously, we could have a whole hearing gopsbout how badly the aca repeal bill will hamper the progress that we just passed in 21st century cares. I just want to draw attention to one part of this op ed where the authors wrote, repealing the aca and its Behavioral Health physicians will have stark effects on those with Behavioral Health. We estimate that approximately 1,253,000 people with serious mental disorders and about 2. 8 million americans with substance have disorders, of whom opioid disorders will lose some coverage. Their the end of the day, we dont know what kind of bill will reach the president s desk desk but if we really want to address the Opioid Crisis we i suggest we dont pass the severely poorly thought out piece of legislation. I yelled back. Mr. Walden for five minutes. Mr. Walden the opiate crisis as we know, has touched every corner of our nation. If i colleagues, i met with community leaders, physicians, First Responders, law on thisent and families issue. Each share their heartbreaking stories on the effect of this crisis in our communities. You see addiction doesnt , understand politics it doesnt , understand income, doesnt understand race, where someone is from. It is an equal opportunity destroyer. This crisis has hit close to home for all of us. Last congress, this committee worked in a bipartisan way to pass legislation to fight the way we avoid epidemic. The Opioid Epidemic. In an effort that began in the subcommittee that held a series of communities about the growing problems of Prescription Drug inherent abuse. We should be proud of those we will discuss us today. There is a new threat emerging. Last year, there were encouraging reports that the prescriptions for the opioid had finally declined. That was good news. For the first time in 20 years, that it happened. Yet, we saw the overdoses and overdose related deaths continuing to surge upward, and we ask why . Emerging data strongly suggest the main drivers fentanyl and its chemical variations. Fentanyl essentially represents a third wave of the Opioid Crisis. It is why we are here. Fentanyl is a more challenging threat within the Opioid Crisis in comparison to the threat of production opioid and heroine. The fentanyl threat is multifaceted. It has been produced as a legitimate pain medication and Drug Companies for decades but it has also been produced illicitly in black Market Applications in china. Illicit fentanyl is hard to detect. Nor is it comparable to the black market of heroine. It can be purchased over the internet openly or on the dark web. The chemicals used to make fentanyl are produced in china and shipped to clandestine labs in mexico. Drug cartels are smuggling massive amounts of fentanyl with other narcotics from mexico across the southwest border. Drug traffickers in the United States are not only getting deliveries of sentinel through the mail, but getting direct or indirect shipments from china Phil Presseys that can fuel fuel thises that can epidemic. Fentanyl is not a replacement drug for heroin or oxycontin. 2 to 3 milligrams can kill an individual, and has. Added into cocaine or heroin to boost the likelihood of an addiction. Those taking these drugs may not know that they are taking fentanyl, linda known what it is let alone what it is. And 2015 in oregon, 49 people died from fentanyl. The number of deaths appear to be rising. That is just what we know. As we work to combat this threat, there is an important question to ask, how can we find this threat when we dont know how quickly it is spreading . Threatng the fentanyl will require more than strategies on overprescribing. Fentanyl is a global problem that requires an urgent response. I commend our government efforts for their success in gaining cooperation with china andt he united nations. We need to support this International Engagement to be successful. Requires anntanyl all hands on deck effort. We have to think outside of the box. I look forward to your testimony in solving this problem. D peeled the balance i yiel the balance of my time. Thank you mr. Chairman. This issue is of concern to me. I have been on the Health Subcommittee long enough. In 2005 we were having a hearing about why doctors were not prescribing adequately for pain. Now we have been concerned about the Opioid Epidemic. Fentanyl has been around for some time. The analogues to fentanyl are relatively new. It is the feeling of Illicit Trade with the ability to get things over the internet that has been the crux of this problem. We have problems with the overseas market. I hope we can hear some insight this morning on additional things to stop the flow. Thank you mr. Chairman and i will yield back to the gentleman from oregon. I recognize the Ranking Member of the committee for 5 minutes. The Opioid Epidemic continues to grow at an alarming rate. In 2015 more than 33,000 americans died of overdoses. According to the center for disease control, 91 americans die every day from an opioid overdose. We are focusing on fentanyl, a synthetic opioid that is 100 times more potent than morphine. Because of its potency, fentanyl results in frequent overdoses that can cause respiratory depression and death. The number of Overdose Deaths is rapidly increasing. The death rate from synthetic opioids increased 72 from 2014 to 2015. This substantial increase from synthetic opioids is largely attributable to the increase of illicit fentanyl. I want to thank our witnesses on this important issue. Fentanyl is dangers not only to users dangerous not only to users but Law Enforcement officials on the front lines. I look for better ways to extend the supply plaguing our communities. Stem the supply plaguing our communities. Rushed ago, republicans trumpcare through the committee. The aca has been instrumental in addressing the Opioid Crisis. Inexcusably, trumpcare would exacerbate the crisis. Thanks to the aca 1. 6 Million People with Substance Abuse disorders can receive the treatment they need. Trumpcare eventually ends Medicaid Expansion in 2020. Bo,ording to the c trumpcare cuts medicaid over the next 10 years, which severely undermines our efforts to fight the Opioid Crisis. These will russian care for millions of americans, including Substance Abuse treatment. Essentialreveals Health Benefits for Medicaid Expansion enrollees at the end of 2016. Offer no longer have to Prescription Drugs to americans that rely on such care. Repealing the essential benefits remove would approximately 5. 5 billion annually for the treatment of low income people with mental and Substance Abuse disorders. The repeal would take care from those seeking services, and we cannot eliminate this care and what is often a life and death situation. Tompcare threatens access lifesaving treatment for one Million People with lifesaving disorders. I would argue this issue is part of a much wider problem we are battling. We must make sure americans with Substance Abuse disorders can access the effective treatment. Andnt to confront fentanyl the larger opioid problem. In my opinion, repealing the aca and cutting medicaid by 1 trillion will do nothing but undermine our efforts to treat americans that are suffering from opioid addiction. We cannot arrest our way out of this problem. Without adequate treatment options, this problem will only worsen, and so will the death and destruction we have seen play out across the United States. I dont know if anyone wants my extra minute. I yield back. I want to offer for the record a article from the washington post, where opiates kill the most people in 2015. Ps where these occurred throughout the country. Synthetic opioid rates in West Virginia, rhode island, and other aspects. There is not one opiate epidemic, but several. There is no silver bullet. Whatever this committee finds, we have to give maximum flexibility to the states to work this out. I ask unanimous consent that the opening members statements be entered into the record. I would like to introduce our p