Minutes. Good morning, welcome to this hearing. Called fentanyl the next wave of the Opioid Crisis. America is a full on Opioid Crisis. Two decades ago it started with the overprescribing of opioid drugs. Then it shifted more to heroine. Today, the subcommittee examines the next wave of the Opioid Crisis in a more dangerous threat to our streets, fentanyl. Since all is made in a lab and for many years that has been a powerful pain medication with patient for cancer. I would add to this when i remembered when i was injured in iraq a few years ago, Battlefield Medicine meant in recovery, they give me lots of fentanyl patches and i know what its like to have the reaction to it. Its 50 times more potent than heroin. One hundred more times quoted than morphine. Now fentanyl has become an additive to even counter. Prescription drugs. Drug dealers increase supply, get more addicts sort of like mst and foods. Users often dont even know that fentanyl is in the heroine. Fentanyl crisis is exceptionally dangerous because of its high potency, the speed with which it reaches the brain. Two mg of fentanyl until, whether swallowed, and inhaled, or through the skin. Appreciate how small amount 2 milligrams is. A sweetener packet that you see at your restaurant table is about a thousand milligrams. 2 milligrams of fentanyl until you. Those suffering from an overdose involving fentanyl may require both higher doses and multiple administrations of the lock so to to stabilize. Even the police and First Responders are at risk from inadvertently and touching or inhaling the top powder at the crime seems forceful helping in overdose victim. In 15 the Drug Enforcement administration or dea issued an alert on fentanyl is alert to public safety. The dea sent another flirts called it an unprecedented threat. Custom orders show an 83 and added challenge is that there are many chemical variations known as analogs. There are about 30 known analogs, however none none of them are controlled substances under federal law. Since 2013, overdoses have death have served with no end in sight. Fentanyl and have contributed to at least 5000 overdoses death in the United States including the death of music star prince, last year. In my district alone fat and all related deaths exploded since 2014, last year 86 last year 86 people in west born county died from Drug Overdose link in part fentanyl. Even these statistics undercut the fentanyl threat nationally because most states and localities are not testing or tracking fentanyl and Drug Overdose cases. We are flying blind. At this case the capacity of Law Enforcement in the Healthcare System will be overwhelmed. China is a primary source of fentanyl and there are thousands of labs making illicit peer fentanyl as well as the source of ingredients or precursors needed to manufacture and all. Topic or sip these ingredients to secret labs in mexico, run by drug cartels and smuggled pounds of that and all over the southwest border through our porous borders, launching it to catapults and into the us. Chinese labs are also a primary source of fentanyl order on the open internet and down the dark web. Peer fentanyl is delivered through the mail or express 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 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 profit is enormous. According to the data from dea a kilogram of color and can be purchased for roughly 6000. An sold hotel for 80,000. Over 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 camping. Therefore while the each kilogram to be sold for sale 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 is a 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 with people to stop the spread of this epic dominic. I recognize my friend from colorado. Thank you, mr. Chairman. Every 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 distributor. Its an Even Deadlier layer to this crisis. It can be up to 50 times more potent than harridan. And a hundred more times than morphine. It leaves even the tiniest amount and anyone exposed to it can have it detrimental. Illicit fentanyl is not a new problem. What is new is its growing prevalence. This 2010 that number covered by the american Law Enforcement nationwide enters in 20 fold from 640 samples tested to 13000 samples tested in 2015. According to information from the da. Us Law Enforcement as the chairman said believes china is the primary source of illicit but small and precursor chemicals. 20s producers shipped fentanyl and chemicals to make it directly into the United States. The precursor chemicals shipped to mexico and canada where traffic across our border in pure form or mixed with other illicit drug like karen. Today, we want want to ask the panel some tough questions about Law Enforcement and diplomatic efforts to extend from china and whether there sufficient. Were also going to ask which drug traffickers use to ship this drug into our country like, express consignment care is an international nail. 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 epidemic and this is sadly where i have significant differences with my majority colleague. Passage of the Affordable Care act has led to nearly 20 million americans Getting Health Care coverage. In addition, the aca has been able to governors to expand the Medicaid Services they offer, which is critical in states that were overwhelmed by the Opioid Epidemic. Studies estimate that since 2141. 6 million uninsured americans gain access to Substance Abuse treatment across the 31 states like mine, when expanded medicaid coverage. This is particularly important for states like kentucky where one Study Reports that residents saw 700 increase in medicaid beneficiary 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. Its an assessment of the bill last week that the Congressional Budget Office said that millions of americans, 2,424,000,000 of them will Lose Health Coverage at many of those will be people currently receiving medicaid assistance which includes people receiving treatment for opiate addiction. In january, healthcare aspects from harvard and nyu wrote a thing to the hill about repealing the aca would reverse Important Health gauge. They focus primarily on my baby, the 21st century care act which i did with this Care Committee that we approved unanimously but we could have a full hearing just about how badly the gop, aca repeal bill will half of the progress that we just passed in 21st century cares. I i just want to draw attention to one part where the authors wrote quote repealing the aca and its Behavioral Health positions will have dark effect on those with Behavioral Health and insist. We estimate that approximately 1,253,000 people with serious mental disorders and about 2. 8 million americans with Substance Abuse disorder of about 222,000 have 22000 having opioid disorder will lose some or all of their insurance coverage. 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. I recognize mr. Walden for five minutes. Thank you, first hearing this Opioid Crisis. If you touch every part of our nation. Like my colleagues i met with community leaders, physicians, Law Enforcement, and families on this issue. Each share their heartbreaking stories on the effect of this crisis in our communities. See addiction doesnt understand politics. It doesnt understand income, doesnt understand race, where someone is from, its an its an equal opportunity destroyer. This crisis has hit close to home for all of us. Last congress, this committee worked in a pipe parts a way to pass legislation to fight the way we avoid 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 efforts but as he will discuss today there is a new threat emerging. Last year, there were encouraging reports that the prescriptions for the opioid had finally decline. That was good news. For the first time in 20 years, that it happened. Yet, we saw the overdoses and overdoses death continuing to search upward. We ask why . Emerging data strongly suggest that the main driver is bentall. And its chemical variations. Fentanyl essentially represents a third wave of the Opioid Crisis. If i were here. Fentanyl is a more challenging threat within the ip droid crisis in comparison to the threat of prescription rights inherent in. The fentanyl threat is multifaceted and produces legitimate pain medication and Drug Companies for decades but it is also produce it illicitly and blackmarket art in china. Illicit fentanyl is hard to detect and like to unlike pain is not diverted from the main market. Nor is it comparable to the black market of heroine. It can be purchased over the dark web or the internet openly. 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. Traffickers in the United States not only are getting deliveries from fentanyl from china through the mail or through express carriers but theyre also getting through indirect segments from china to the can make thousands of pills in our to appeal our operations into our towns our communities and the lives of our citizens. Peer fentanyl is not considered a replacement drug for oxycontin or heroin it is to put in. It is two to 3 milligrams until end of individual. More often than not it is added into heroin, cocaine or other counterfeit drugs to increase the likelihood of addiction. With even scarier is that people taking these drugs do not even know that theyre taking that no, let alone what it is. Fentanyl makes the deadly threat of opioid abuse Even Deadlier. In 2014 and in 2015, in, in my home state of oregon, 49 people died from fentanyl. The number of deaths from fentanyl appears to be rising and thats just what we know. As we work to combat this quickly Public Health threat there is an important question be asked. How can we fight this threat when we dont know how quickly it is spreading . Combating this threat will require more drug control strategies aimed at prescribing opioid is a global problem that requires urgent response. I commend the efforts of her government, dea and the state department particularly for their success in gaining cooperation with china and the united nations. We need to continue the support of an International Engagement to be successful. Like our work on the Opioid Epidemic last congress, combating that no requires an all hands on deck attitude. We need to think outside of the box to stop the surge of the fentanyl crisis. I look forward to working with you. I yield my time to mr. Burgess. Thank you, mr. Chairman. Thank you for holding the hearing. I want to thank the dea and you been into my office to talk about this issue in the past 101. It. It is a concern to me. Ive been on the Health Summit committee long enough that in 2005 we were having a Committee Hearing about why doctors were prescribing adequately for pain and now the past two congress is me big concern the appearance of the Opioid Epidemic. But small is not new product, it has been around for some time but on the other hand it is the fueling of the Illicit Trade with the ability to get things over the internet which i think has been probably the crux of this problem. We do have problems with the overseas market with the way the supply comes into our country so i hope we can hear insight this morning into the additional things that might be done to stop the flow. Thank you, mr. Chairman. I yield back my time. We recognize mr. Thank you mr. Chairman. The Opioid Epidemic continues to grow at an alarming rate. In 2015 more than 33,000 americans died of an opioid overdose. More than 2 million individuals hadnt opioid disorder. According to the center for disease control, 91 americans die every day from opioid overdose. Today were focusing on fentanyl but is 50 times more put then haired heroin. Because of its potency fentanyl is a dangerous substitute for heroin and results in frequent overdose that can close respiratory, depression and even death. The number of overdoses is rapidly increasing. If death rate from synthetic other than methadone increases by 72 from 2014 to 2015. The substantial increase in the. The substantial increase in the death rate from synthetic opioid is largely attributed to the increase availability of fentanyl. I want to think our witnesses for their testimony and work on this very important issue. Fentanyl is dangerous, not only to users but also to our Law Enforcement and Public Health officials on the front lines of this epidemic. I look forward to working together to create ways to confront supply that is plaguing our communities. I would also like to talk today about the treatment side of the Opioid Epidemic. Two weeks ago, many republicans rushed care to the committee, a bill that would repeal the Affordable Care act. The aca has been instrumental in addressing the current Opioid Crisis and in especially, to compare would only exaggerate the crisis. The Medicaid Expansion under the aca, 1. 6 1. 6 Million People with Substance Abuse disorders can receive treatment that they need in the 31 states. Care effectively and Medicaid Expansion in 2020. According to the cbo trump care also cost 880 costs for medicaid over the next ten years which will severely. Were taking care from millions of americans especially those with substance care treatment. Care also states were no longer have to offer benefits like Substance Abuse, Mental Health services or Prescription Drugs to millions of americans rely on such care. Repealing the essential benefits package effectively repeals the mental and subterfuge provisions of the aca. It would remove approximately 5. 5 billion annually from the treatment of low income people with mental and Substance Abuse disorders. Repeal will take away the care from those were actively seeking treatment and Preventative Services and we simply cannot afford to eliminate this care and what is often called a life and death situation. Trump care threatens access to lifesaving treatment for more than 1 Million People with opioid disorders. Our hearing today explores th