The 2016 we learned from the New York Times weve lost roughly 60,000 people to Drug Overdoses. That is more in one year that all the names on the Vietnam VeteransMemorial Wall and likely, that number is underestimated because much of the data will not be in until the end of this year, 2017. Its staggering. For every fatal overdose its estimated there are 20 nonfatal overdoses and for 2016 that could mean your 1 million. 183,000 lives have been lost in the us from overdoses between 2015. Thats about 50,000 we lost over the last, 500,000 we lost over the next decade. The roots of this crisis began in 1980 when a letter to the editor in the journal of medicine was misinterpreted as evidence. It was unlikely someone become addicted out of 4000 cases a center was only four connections. Years later the joint Commission Following the american medical associations recommendation assessment established standards for Pain Management interpreted by many doctors as encouraging the prescription of opioids. Under the Affordable Care act, prescribing opioids is incentivized where that pain was adequately addressed. Based on their answer, they may receive more or less money. As we learned in our oversight hearing held in march the Opioid Epidemic is an Urgent Public Health threat fueled by a much more synthetic open opioid and a clear and present danger. Stage represented on todays panel, were the first ones hit by the fentanil wave and it seems certain this way will sweep the nation as hard to detect profile of fentanil is increasingly attracted to traffickers and easy to manufacture over the internet. This is an in extremist moments requiring all the experience, resources, cooperation of our federal, state and local governments as well as Different Industries to curb this terrible outbreak. His hearing we will focus on the actions of our State Governments to find out what efforts are working, not working and how we can Work Together to save lives. We want to know the problem and please be candid with us. As you know, there are families being torn apart by this. The drug industry, as one policy experts, sally petrone noted it is at the state and local level that the progress will be made. It makes sense that efforts to find solutions the most concentrated there and we should invest in those solutions and learn from them. State governments have been pursuing a innovative initiatives as well as inventive use of incentives, structured medication and more comprehensive Prescription Drug monitoring. States such as maryland are making the best use of the opioid prescribing guidelines to prevent overprescribing. Kentuckys electronic reporting system known as casper where they had Monitoring Systems to help your prescriptions lose use across the state helping regulators identify questionable prescribing practices by physicians and abused by patients. Virginia has expanded access to the lots owned, the drug that can reverse an overdose that can have its own risk in its use. Some states are expanding the availability of naloxone by prescribing family and friends and individuals who are susceptible to overdose. Rhode island has developed a program that matches overdose victims with your recovery to encourage treatment for the next 10 days after the overdose. Much of the work of the states should help inform the president Opioid Crisis. Three years ago the subCommittee Held a hearing on what State Governments were doing to combat the opioid abuse epidemic. The oversight helped congress and asked kera and help that will help the administration put 1 million of grant for the next two years but we want to know if this money is being used wisely and whether its working. We are eager to learn about those programs. The Security State program is just the beginning. Our State Government assistance can help these cities develop a more Effective National strategy to combat the Opioid Crisis in areas of Substance Abuse prevention and education, training, treatment and recovery, Law Enforcement expanded access while testing for drugs in correctional facilities, Data Collection and determining what reforms can men be made to the cfr and better coordination among care among physicians and we can prevent relapses and improve patient safety. We are in one of the worst medical tragedies of our time , perhaps the worst. Although this committee has given the subcommittees attention to many other problems in the past, we recognize this is paramount among them. This is a National Emergency and we look forward to hearing from the states and what you are doing on the frontline and i yield to my colleague. Thank you so much mister chairman and i appreciate this most recent hearing on opioid addiction. As you said, so accurately, this crisis is really devastating america as all of us in our community. Urban and rural alike, not a day passes without a report about children watching their parents overdose, about librarians and School Nurses being trained to administer naloxone to overdose victims, about local and State Governments trying to respond to the issues surrounding addiction. All of the same time trying to stay within their budgets. There is some good news, recently the cdc reported that opioid prescriptions in 2010 peaked and has since fallen by 41 percent. Thats the good news. The bad news is opioid prescribing remains uncannily high and im hoping our future investigations will concentrate on that. In addition as you pointed out mister chairman, as the emergence of illegal fentanil which is an exceptionally potent opioid. In 2017 fentanil undertook heroin and prescription opioids as the leading cause of death in many places. Each of the state who are here today and i want to thank you all for coming out these alarming overdose outbreaks rate due to this drugpervasive used in this nation. This committee has done good work , in particular investigating the seemingly voluminous amount of coke distributed in West Virginia and i know we are planning to do more. As you know, a number of secretarygeneral are investigating manufacturers and in some cases distributors. The attorney general in my home state of colorado for example has joined a Bipartisan Coalition of states nationwide looking into whether manufacturers engaged in illegal or deceptive practices when marketing opioids. Coming up with an effective solution to the Opioid Epidemic will require us to understand the actions of all actors. I hope to hear from from the sum of the states today on what role they believe drug manufacturers and distributors maybe adding to the crisis. Also, i look forward to hearing from the panel about the impact of fentanil on the towns and communities in which they work. States really are on the frontline of fighting this crisis and i look forward to hearing from all of you. I know rhode island for example has led the way in reconnecting people with Substance Abuse disorders to highly trained coaches to guide them through recovery. Virginia isworking to implement a similar pure Recovery Program and kentucky has established a program to provide medication , assistant treatment to individuals in correctional facilities and to continue supporting them after their release. Maryland has committed to establishing 24 hour Crisis Centers in Baltimore City. Mister chairman, i know these are all great state efforts, weve made some efforts here in congress and i appreciate you referring to the 21st century care legislation that congressman absent and i sponsored and that this whole community Work Together on a bipartisan basis to pass but as we work to move forward on this issue, we need to Work Together to continue to address this and thats why i kind of hate to be the fly in the ointment and talk about what these effort to repeal the Affordable Care act will do to the fight against the Opioid Epidemic. As you know, the aca has helped nearly 20 million americans obtain health care coverage. In addition, its enable governors to expand Medicaid Services critical to the fight. For example, studies show that since 2014, 1. 6 million americans gained access to Substance Abuse treatment across the 31 states that expanded medicaid coverage. This is particularly true for hardhit states like kentucky where one Study Reports that residents saw a 700 percent increase in medicaid beneficiaries facing treatment for Substance Abuse. Many people think that the house passed bill that undermines the aca will threaten peoples ability to get opioid treatment. And its assessment, the nonpartisan cbo said the house bill would cost 3 million or 22 million americans to lose Health Insurance. A lot of these people, they need opioid treatment. There have been discussions both in the house bill and send discussions about adding some money for opioid treatment but for example, the most recent senate suggestion of an additional 45 billion to help combat opioid addiction, Governor John Kasich said its like spitting in the ocean, its not enough. We have to understand access to healthcare treatment is what is going to help with the health of all americans including the opioid addiction andweve got to move forward to work on this together. I hope we can do that and with that i will yield back. Vice chairman and full committee, mister walden. Addiction is an equal opportunity destroyer. Its a crisis that is not attack people based on their race, age or socioeconomic status and does not pick them based on political parties. My own table through origami, it didnt matter if i was in a Rural Community or more popular city, the stories were similar and i we all know someone weve been impacted. In my state, more people die from drugrelated overdoses and automobile accidents and sadly thats not unique. According to preliminary data, Drug Overdose death in 2016 exceeded 59,000 people. Thats the largest annual jump ever recorded in the United States and whats worse, some of the preliminary numbers from the state indicate there are numbers within the First Six Months of this year are already surpassing last years total numbers and over the past seven years, opioid addiction diagnoses were up 500 percent according to a recent report. The bible report released by the centers for Disease Control indicate the number of opioid prescriptions has decreased over the last five years, thats the good news. The rates are still three times as high as they were in 1999 and the amount of opioids prescribed in 2015 was enough for every american to be medicated around the clock for three weeks. That report also found the counties in oregon on how some of the highest levels of opioid prescriptions in the country, of top 10 counties in my state for opioid prescriptions, five of them are in my rural districts. Organizes the five and older are being hospitalized for overdoses and other complications and a far higher rate than any other state in the union. Sadly, Overdose Deaths in this epidemic are simply getting worse and more severe. So challenges remain and we need to get accurate. First we need to improve Data Collection and a few states are requiring more specific information related to Overdose Deaths by simply, we cannot solve what we do not know. We need to be able to have more reliable data so we can better understand or address the full scope of the problem. There also needs to be an increase in Overdose Prevention efforts, improvement with respect to the utilization and operability of Prescription DrugMonitoring Programs and we need to increase access to programs including medication assisted frequent. And this epidemic requires an all hands on deck effort from federal, state and local officials and all of us standing from healthcare efforts to local Law Enforcement community. Its precisely why we are having this hearing today. Action to combat the spices by passing legislation including the comprehensive Addiction Recovery act and the 21st century jurors act and state to pursue programs that strengthen our fight against his academic. But much more needs to be done. We need to Work Together to ensure the tools and Funding Congress has created are reaching our state counties and they are being used effectively. We will hear from state officials today and see how they are utilizing these funds and whether these programs work or not. We greatly appreciate the witnesses who have agreed to appear before us today. We hope to have a constructive dialogue about what the states are doing, how we can improve Data Collection, initiatives are working and how the federal government can be a better partner. We look forward to your testimony and working with all of you and our Community Leaders to help get our hands on this or crisis so thank you for being here. With that i have to members that want to introduce witnesses to allow the first to mister buckley. 90 mister chairman for letting me sit in for purposes of introduction. I went to introduce our secretary in kentucky, secretary tilly. Been friends for a long time and served in the General Assembly together. Secretary tilly had a strong reputation as judiciary chairman working with the senate to produce legislation that i think is landmark and was very important. And we have so much to do in kentucky, 1404 people that passed away last year from opioid addiction. Theres so much to be done were saying thank you for the work youve done, i know we have enormous work to be done and i can tell my colleagues in the committee and my friends that i can think of nobody else in kentucky id rather have leading this effort and i applaud the governor for making the choice and asked to serve in his cabinet and appreciate your willingness to do so and i think you will make again. I recognize the gentleman from virginia mister gifford. I appreciate that. Id like to introduce secretary brian moran. Brian was prosecutor first when he came to the Virginia House of delegates where he and i served, he was a leader on the other side of the island but he was always a pleasure to work with and i appreciated his work very much and he became the first secretary of Homeland Security in virginia sensory and has oversight over 11 agencies but is generally well reasoned. Every now and again we would disagree on the floor of the house but we Work Together on a number of things and i apologize, Mister Guthrie and i have to run to another committee where we have two bills that are upstairs so i wont be able to stay but i will read with interest your testimony and learn from my colleagues the good work that you have to say and welcome you to our committee and apologize that i cant be here because im defending a bill upstairs. With that i will yield back the balance of my time andunfortunately i too must go to that subcommittee. Secretary moran is the spitting image of his brother and i recognize the chairman for five c minutes. Thank you mister chairman thank you for holding this hearing on this critical issue. Our Committee Held several meetings on the Opioid Crisis including one in march, the Opioid Epidemic is not letting up and neither can our efforts to fight. Our last year and many more lives have been destroyed and theres no community that remains untouched by the Opioid Crisis. Recently the cdc reported the opioid prescribing rates as the butt remains far too high with enough opioid every american medicated around the clock for three weeks and im glad we have the states here today so we can hear about what they are seeing on the front lines and what successful approaches have found that deserve to be replicated and what challenges they face. Id like to hear from our witnesses about how the federal government can help support in this case and the power to address the challenges of the community, our response to this epidemic cannot be 51 separate efforts. We must harness our Resources Data in cooperation to get this crisis under c