Transcripts For CSPAN2 White House Director On Drug Policy Testifies On Overdoses 20240707

access comprehensive treatment and care and when it comes to the bad actors that fuel the crisis, like mckenzie, i've used this gavel to hold them accountable for their actions. this hearing comes at a difficult moment for our nation. overdose deaths in america have been rising for more than two decades and during the coronavirus pandemic, fatal overdoses skyrocketed to historic levels, tragically, overdose test increased by 30% in 2,020 and 15% in 2,020 one. more than 100,000 lives were lost, the biden/harris administration and democrats in congress have taken aggressive action to address the supply and demand factors contributed to this crisis. since president biden took office, stopping fentanyl at the border more than ever before. this administration has increased drug interceptions, seizing roughly 800 pounds of fentanyl each month. this represents a fourfold increase in fentanyl interdiction over the previous administration's efforts in 2019. to build on this progress president biden's 2023 budget calls for 10% in additional funding in interdiction efforts, a request i hope all my colleagues will support. at the same time the biden harris administration and congress have made significant progress in treating addiction as the disease that it is by expanding access to treatment and wraparound services. the american rescue plan allocated nearly $4 billion to services for mental health and substance abuse disorder. that law also created the first federal fund for harm reduction services. additionally the administration's overdose prevention strategy invested tens of millions in initiatives to reach underserved communities to combat stigma and expand access to lifesaving treatment. these stabilized and i'm grateful this administration has prioritized that. today we will hear from doctor rahul gupta, director of the white house office of national drug control policy. who will testify about the biden administration's 2022 drug control strategy. this national strategy focuses on what works, uses evidence-based strategy to build on progress already made by the administration and outlines the plan to invest in communities, prevent substance abuse and increase access to treatment and recovery services. the national strategy takes bold steps to ensure medication to reverse overdoses is available to anyone in a moment of crisis. strong bipartisan priority that will save lives, strategy that for most axis to fentanyl, test strips which are a vital tool for overdose protection especially among young adults, the national strategy also builds on the administration's progress to disrupt supply of dangerous substances into the west by targeting transnational criminal organizations that are manufacturing and trafficking fentanyl, the seer's national strategy goes further than any prior drug control strategy to address structural inequities that lead people in some communities with insufficient access to healthcare and makes the more likely to be pulled into the criminal justice system as a result of drug misuse. the overdose crisis affects every community represented by our committee members here today, democrats and republicans, we owe it to our constituents to do everything we can to build on the administration's progress and work together to advance solutions to this public health crisis. that includes setting to the president's desk a strong substance abuse disorder package that the house approved last week. it also means passing hr 6311, the care act, a bill i offered and introduced with senator elizabeth warren and others that advances the objectives of the national drug control strategy by providing crucial resources to the local community on the front lines of this public health crisis. i think director rahul gupta for appearing today and for the biden/harris's commitment to ending our nation's overdose crisis. i now yield to my good friend, ranking member comeer for his opening statement. >> thank you, chairwoman for calling this hearing today. our committee's mission is govern efficiency and effectiveness which are committee's mission is to prevent taxpayer dollars from government fraud, waste, and abuse. are committee's mission is to hold government officials accountable. republicans on this committee have been pushing for months to hold hearings on the many pressing crises felt by the biden administration. i'm pleased we finally have a top-level biden official testifying today, i must say this is long past due. i urge the chairwoman to hold more hearings like this where we can examine the many crises impacting america today. thank you, rahul gupta, for testifying today. in january republicans on the energy and commerce committee launched an investigation into america's fentanyl crisis. we sent letters to the office of drug control policy, customs and border protection in the dea seeking information about the plan to address the crisis at the southern border and overdose epidemic, we appreciated the response from your agency but many important questions remain unanswered. one of these outstanding questions is how president biden's border crisis and this administration's open border policies aided and abetted practicing of illicit drugs like fentanyl in our country which is being smuggled across the southwest border at unprecedented rates. u.s. customs and border protection seized 11,000 pounds of fentanyl in fiscal year 2021, more fentanyl seized in one fiscal year than 2020-2019 combined. the standard overdose of fentanyl is two milligrams. 11,000 pounds of fentanyl is 5 billion milligrams. we seized 2. 5 billion lethal doses of fentanyl in one fiscal year. that does not include all the fentanyl we know has been smuggled across our borders and detected. cartels are overwhelming agents, a steady supply for dealers and users alike. a primary question is what is president biden going to do to secure the border and cut off the free flow of illicit drugs into our country. we also wrote an open letter to law enforcement seeking information how the fentanyl crisis is impacting local communities. we received distressing responses from communities across the country telling us the devastating effects fentanyl has had of young lives lost and families destroyed. madame chairwoman i ask unanimous consent to submit these response letters into the record. >> without objection. >> thank you. on top of the crises at the southern border democrat lockdowns and school closures caused increased stress and mental health complications for teens and adults leading to historic overdose rates. according to pulmonary data from the cdc more than one hundred 7,000 people died from drug overdose in the us in 2021. that is a nearly 15% increase over 2020 which is already a 30 one% increase over 2019. our nation's mental health crisis continues to worsen due to the economic hardship and supply chain crises caused by president biden's disastrous policies. studies have shown that stress over money and make people 20 times more likely to attempt suicide. inflation remains at a 4-year high, gas prices the highest in american history and many families are stressed wondering how they are going to make legals meet, tragically fentanyl overdoses are becoming the leading cause of death for americans age 18 to 45. more than covid, car accidents, gun violence, breast cancer or suicide. teenagers and young adults turning to snapchat, tick-tock and other social media apps to find xanax and other pills many of which are counterfeit and laced with fentanyl. fentanyl has been found in marijuana. we must act now to secure the southern border to stem the flow of illicit fentanyl. it is heartbreaking to see how desperately people have tried to escape the impacts of president biden's policies. this administration has flooded the market with illicit drugs so they can do just that. thank you, madam chair and i yield back. >> gentleman yields back, thank you and i would note in response to your statement that we have already held more than 25 hearings this congress, the biden administration officials and other government witnesses, today is the 20 sixth. i have a list of these hearings. without objection i will enter it into the record and now i will introduce our witness. we will hear from doctor rahul gupta, director of national drug control strategy, the witness will be an muted so we can swear him in. raise your right hand. i don't see him up there. is he on? >> i am on. >> i see you now. please raise your right hand, do you swear or affirm the testimony you are about to give is the truth, the whole truth and nothing but the truth so help you god? >> i do. >> lector the records show the witness answered in the affirmative. thank you. without objection your written statement will be made part of the record. with that you are recognized for your testimony. >> members of the committee, thank you for inviting me to testify about president biden's strategy. this strategy was released in a time of unprecedented challenges. for far too many years, the crisis has been unraveling the social fabric of the nation and destroying american lives and livelihoods. the centers for disease control and prevention estimates overdoses of claimed more than one million lives in the past two decades. in 2021 alone we lost 107,000 americans, one life lost every 5 minutes. these are friends, family members, coworkers, neighbors. this 2015 overdose deaths in america have doubled and the covid 19 pandemic has amplified the difficulties in accessing treatment or substance abuse disorders. as a practicing physician for the last 25 years i have treated many patients with addiction who have gone on to lead successful lives but i have also seen too many patients succumbed to their disease and i have attended far too many funerals. working in the emergency room i have experienced weeks and months working overdose every shift. behind these overdoses there are millions of individuals experiencing nonfatal overdoses overwhelming first responders and the healthcare system. underneath these overdoses are tens of millions of americans suffering substance abuse disorder. there are other facts. research estimates economic cost of the epidemic could be a staggering $1 trillion a year and after 26% of the laws in lois that if us labor force participation can be attributed to addiction. addiction and overdose epidemic is a nonpartisan issue which is evidenced by the fact that it touches everyone regardless of where you live or how you vote and this is why ending the opioid epidemic is part of president biden's unity agenda and why it has strong support across the country and across political parties for finding comprehensive and meaningful solutions. as the office of national drug control policy developed this strategy we focus on the fact that this epidemic is being driven largely by untreated addiction and drug trafficking. this strategy focuses on reducing overdose deaths and supply of illicit substances and increasing prevention, reduction, treatment and recovery efforts and finally improving ways the, justice system addresses substance abuse disorder so people get the help they need before it is too late. also four key priorities across the strategy at a time when 3 or 4 overdoses involve opioids it is critical we are making sure everyone can access them. we are looking to ensure everyone gets the treatment, disrupting drug trafficking operations, united states has a fundamental responsibility to protect its borders and this is what the biden administration is doing and we are improving data collection particularly for nonfatal overdoses as they are good indicator of someone encountering a future failover those. taken together these goals usher in a new era of drug policy that is comprehensive, holistic and targeted at saving lives first. our nation is at an inflection point. our actions must rise to the occasion by being bold and innovative but also compassionate and consequential. the biden/harris administration drug control strategy is an unprecedented, evidence-based blueprint designed to save lives immediately, build infrastructure for treating addiction that the nation needs and disrupting drug trafficking and the process that fuels it. all the while ensuring the federal government is accountable and serves as a good steward of taxpayer dollars, saving lives which i believe every life is precious and worth saving. ..his strategy is implemented as intended, we could be saving 164,000 lives over the next three years and help tens of millions of people get into treatment. the president and i are committed to seeing this through because american lives depend on it. because american lives depend on it. thank you for your continued efforts to make our country safer, and as president biden said, let's come together to beat this. i look forward to your questions. >> the gentleman yields back. i now recognize muscle for five minutes for questions. thank you very much, director group to, for coming before the committee to defend her leadership and thank you for your tireless commitment to ending thehe overdose crisis whh has devastated so many families in our country. i know this is been a top priority of the biden-harris administration since day one. director gupta, in addition to issuing this is national drug control strategy, what progress has the administration made so far and expanding access to services and care to prevent overdoses and treat addiction? >> thank you, madam chairwoman. we have had significant progress made. in fact, now that telehealth provisionsns that allow provides to treat addiction across the countrys especially in wirral areas under subcommunities and behind the walls. telehealth including consultation is a crucial aspect of expanding treatment. we know less than one out of ten people today are getting the treatment they need. we have also allowed, dea has mobile vans for methadone as well as take-home methadone. these aspects are helping us improve and expand treatment at a time when people are dying without treatment. we are also make efforts to make sure everyone can get a lock so which is the antidote for opioid overdosef reversal. at the same time we we're alg more and more physicians and providers, others to be able to prescriptions through practice guideline changes so they are able to get more treatment across. so our goal of treating untreated addiction, creating the infrastructure, the american rescue plan has invested $4 billion unprecedented amount and the president has now called for an increase in $3.2 billion, $.75 of the dollar of that increase of the $42 billion budget goes towards making sure expanding treatment, expanding prevention, and expanding recovery services. >> the coronavirus pandemic strain every aspect of the american healthcare system with a disproportionate burden falling on people with addiction and the providers whoho treat them. one way the federal government responded toal this crisis was y promoting the use of telehealth to increase american access to addiction treatment. dr. gupta, doeshe the administration support the continued use of telehealth flexibilities addiction treatment beyond the coronavirus pandemic and can you expand on how it is made available to people, how are they made aware that they can have this type of treatment? >> thank you, chairwoman. it is extremely important for president biden, , for this administration to ensure that telehealth services are available and are t made availae beyond the public health emergency. the reason for that is that especially people in rural areas like my home state of west virginia, who are often not able to drive, not able to take the effort to getta where it's needd because of the plurality, these telehealth services allow much more efforts to be provided to people. it's a time but we need to meet people where they are, and telehealth including phone consultation allows us to do just that. the same goes for people especially in communities of color who already have a difficult time and a delay time accessing services. this is another service that will help us expand treatment. >> last december i led nearly 100 of my colleagues on the democratic side in reintroducing the care act, landmark legislation that would provide 125 million in new federal funding directly to communities that care providers over ten years over, the overdose crisis. director gupta, do you agree we need to provide sustained, comprehensive investment and treatment and care to communities at the front lines ofto this crisis as our care act would do wax why or why not? >> thank you,, chairwoman. it is one of the critical aspects of this particular crisis that i we provide these types of services to folks not just for treatment but be on treatment to provide thatnd support, comprehensive support. so it is important that we think about the ability to get people to help when they need it, where they need it, and efforts like this help us get there quicker and ultimately save lives. >> thank you. i commend the administration for its work to overcome this crisis and reduce the harm it inflicts on our society, and i am a proud partner with you in this work, and you bring invaluable experience to the country from your work in west virginia. i now call on representative norman. >> thank you, chairwoman maloney. doctor, i thank you for taking the time to come, now, , i was listening to your opening words. younk said that biden administration had a topop priority for protecting americans, protecting the border. is this -- did you say that? am i right, he has done a great job of protecting thejo border? >> thank you, congressman for the question. we believe strongly it is an important part of every nation to secure and protect its border. there are a number of things going on in this area is that a think are important to note. as i visit, i speak to the women and men on the board -- >> i don't mean, i've got a limited amount of time. has he taken the steps to close the border? is that what i understand you to mean? >> congressman, thank yout, aga, and the president has taken steps to make sure that our board remains secured. part of -- >> okay. doctor,, okay, this is two different universes. you are saying that the numbers, i assume you agree with the numbers of the illegals come across. we are going to average 585,000 a month. we are up to, what is this, 1.6 apprehensions. donald trump had this, with the wall, had this solved. we had 50, during the three prior years, those on the terror watch list were basically zero. this past year it is sick he on the terrorist watch list. how can you sit there and say that this administration has a goal of protecting americans? i am in the construction business. we had a leak on one of our projects. you stop the leak in the pipe. we had a band that had a leak in the dan. you stop the leak. i mean, really, this is a mischaracterization at best for you to sayn this administration, even if the numbers are completely false. we are getting an unprecedented number of people coming across. we already got three threo 5 million illegals in this country. so i guess we don't want words and we don't want hearings. we want action. all he has to do is build a wall and have designated point of entry. how many times has a vice president been to the border, that you know a? she was supposed to be the biggs are heading to set their county time such actually been to the border to see what's going on? >> i believe that to the vice president to answer. what i can tell you is -- >> zero, zero. she is giggling. she's laughing about it. how many times have you understaffed into the border? >> thank you for the question again. my first week in office i i actually went to our southwest border and it went to mexico. recently last month i went to that border in san diego. i was able to spend a considerable amount of time, and i will say that as the regular mentioned, since last year, beginning, we've apprehended 600,000 pounds of illicit drugs including 11,000 pounds of fentanyl. and i will tell you why that is important speedy that's because it's coming across unfettered, doctor. they are unfettered. they are coming across. that's why the cartels are winning. they are making a billion dollars a month, and they are unfettered coming into this country. the bloodod is on the hands of this administration, , what he's doing. our police officers are sick and tired of the danger they face on the streets today in south carolina because of his in action. i tell you, this is one of the tragedies that's going to be hard toil walk back when this administration will not take ownership and to start touting things he's done, he's opened up this country, our sovereignty is at stake and we are losing it. it astounds me that, i know you're part of the administration but it astounds me you are making the state is because it's just not true with the open borders that he is allowing to happen and endanger everybody in america. >> if i can complete my response. what i'm saying is that that amount of drugs is not in our communities killing americans right now. the proceeds come up to $15 billion, that's 99, we're denying those to the transnational criminal organizations that are often used for crime, for corruption and other events in the host countries that often destabilize fragile democracy and become the cost migration in the first place. i am proud of the work our men and women are doing at the border but also a dimension this problem doesn't start oren end t the border. it starts with precursor shipments in china and in sept as overdose and fatal overdoses in thosean communities. we have to --un >> how many countries -- >> the time of the gentleman has expired. we could have a second round but we have to keep moving. congresswoman norton, you are now recognized. thank you, chair maloney. i am extremely disappointed that the biden administration budgets have proposed prohibiting the districts from spending its local funds on commercializing recreational marijuana. i will be submitting a question for the record on this matter. with that said, since assuming office, the biden administration has shown a robust commitment to advancing equity and censoring recovery over punishment in our federal response to the overdose crisis. in 2022 the strategy clarified further this crucial commitment. dr. gupta, could you explain the racial disparities that currently exist in incarceration and arrests for drug-related offenses, and how have these -- equities in the ways that communities experience overdose crises? dr. gupta: thank you. it is no doubt that the disparities in incarceration that exist and continue to exist have perpetuated a lot of challenges. i would say that the question is with congress, and i will leave it with that. having said that, the president has been very clear that he supports decisions regarding legalization of marijuana to individual states, but at the federal level he has supported decriminalization of marijuana use and automatic disparagement of records because of the disparities in incarceration. one thing we are doing in this strategy is looking at all of the metrics available to us and where the data makes sense. we were able to put forward a state model on deflection of the idea that for nonviolent crime, if someone has a mental health disorder or addiction, get the person help, treatment, figure out housing, let's get them other things instead of incarcerating them. it is not only a good thing to do that prevents recidivism, but it is cost-effective for the community. it is these kinds of things that the strategy looks a and is figuring out how to solve problems with the lens of equity additive. sen. norman: to address the inequities in our criminal justice strategy urging the department of justice to identify opportunities to amend federal statutes requiring mandatory minimums for drug related offenses and it calls for greater over governmental collaboration to address the root causes. how have these steps -- how will these steps advance racial equity in our federal response to the overdose crisis? dr. gupta: thank you, congresswoman. as a physician who has practiced for 25 years i've seen the effect of not only for individuals, but their families, and communities. it is important for the administration to make sure we are looking at every option and every possible way to have both judicial independence and figure out what the best way forward in ensuring we are addressing equity at the same time we are addressing the drug crisis that is happening. it is important for us, as i mentioned, to look up the alternatives that includes drug courts, making sure people have the help while incarcerated. we know that two out of three people behind the wall have a substance abuse disorder or addiction. it is important for us to make sure people are getting the treatment both behind the walls but also upon reentry. the reason is, is that is a commonsense smart way to save lives, but also have money and have more productive communities. up to 25%, 20 6% of the labor force participation loss has been because of addiction and we need to change that. looking at it through the lens of equity is an important piece of doing that. sen. holmes norton: proposing steps for the federal government to better understand these recreational inequities across our criminal justice system. it calls for universal substance use disorder screening for people who are arrested. how will these steps help to ensure that people in incarcerated settings have access they need to treat addiction, and why is this such an important -- sen. maloney: the gentlelady's 's time has expired. dr. gupta: the federal government is working on that for federal prisons, because we want to walk the talk. we want to make sure we are leading. we are working with the department of justice, dea, hhs to provide treatment behind the walls to have productive communities at reentry. sen. maloney: representative cloud, you are recognized. rep. foxx: this is virginia foxx, i believe i was next. rep. cloud: she can go next. sen. maloney: thank you, michael. rep. foxx: it is interesting to me that you say behind the walls. it is impossible for you to say people in prison, i guess. what percentage of drugs coming across the southern border are fentanyl were laced with fentanyl? -- or laced with fentanyl? dr. gupta: i can speak on seizures. repl foxx: what percentage are fentanyl or are laced with fentanyl? dr. gupta: i can get you that data. sen. foxx: i think it is most of them. what policies has this administration implemented to stop it? i would like you to say 1, 2, 3, 4 policies. do not go into extraneous information, please. dr. gupta: yes, congressman. first of all, there is the united states-mexico framework that is looking at particular policies that fueled the trafficking, that fuels the transfer across the border, and works with mexico as a partner to make sure we are working on that. second, the president signed an executive order that expands the prosecution and sanctions to not just individual traffickers but the enablers and financiers. i can provide details later on to you. sen. foxx: the first thing that you gave, nothing. there is nothing in what you said. it is working on an agreement. so, nothing there. you are saying one thing and i will look for the details. during the trump administration we saw the first annual decrease in overdose deaths and 30 years with the trump dhs setting an all-time high for the amount of drugs seized at the border and the trump administration rewarded an record amount of federal grants in support of drug intervention in public health programs. what can we do to replicate this kind of success moving forward, and why hasn't the biden administration already checked those programs in place? dr. gupta: as the west virginia health commissioner at the time during 2018 the deaths from fentanyl went up by 10%. the decrease was not, unfortunately, in fentanyl in that time. two weeks ago the cdc provided the first 12 month numbers that have shown a few hundred decline in the deaths over a 12 month period from month-to-month. sen. foxx: let us have that information. we would like to be able to compare what happened during the trump administration with what is happening, because that is not what we understand. the trump administration's stamps on security at the southern border helped make america safer, stop the flow of opioids into the nation, and reduce overdose deaths, but the biting administration's -- but the biden's an illustration stance is allowing overdose deaths to continue increasing, despite what you are saying. without addressing our southern border security we cannot stop the flow of fentanyl into the country. according to the cdc in 2021 more than 107 thousand people died from drug overdose, up from 91,799 in 2020. why has the biden administration failed to bring down overdose deaths? dr. gupta: thank you, congresswoman. i believe we are seeing now a blunting of the curve of those deaths. we know there are multiple factors and we know it is important to secure our border and continue to secure our border. that is why president biden proposed a budget increase of $300 million for customs border protection or the drug budget. it is important we provide the men and women on the border in uniform the resources and technology and infrastructure that they need to do the job they are supposed too.n.oxx: co gupta. you can't believe that. as a physician who has served in rural communities, can you describe what should be done to protect rural communities from fentanyl and dangerous opioids? dr. gupta: first we have to get naloxone out there. we can prevent 80,000 deaths, a majority, if we can get naloxone out there and connect with the treatment. we need a robust law-enforcement enforcement drug trafficking program. they are bringing in local, state, federal partners to work collectively and doing a great job. it is a combination of public health and public safety, especially in rural communities. sen. foxx: you seem to know what to do but you are not doing it. thank you, madam chair. sen. maloney: representative lynch? rep. lynch: thank you for joining us, and thank you for your good work. i have been at this for a while and we have had a difficult time in addressing the drug problem in this country. we seem to have gone from a policy where we tried to get people clean and sober toy policy where we now try to get them off one drugged and put them on another drug, and i'm speaking specifically about suboxone and how we have taken the lid off and allowed doctors to have hundreds of patients and just give them suboxone and not really deliver any behavioral health services that would get at the underlying addictive activity. those individuals that i'm seeing in my district where we have a couple of clinics that handout suboxone, the patient's go out the door -- the patients go out the door and they trade that or they buy fentanyl or methamphetamines, which is even a worse problem. they cannot get high with the suboxone, so they are going to harder drugs and we are seeing much more violent activity. an individual on methamphetamines might be up for days and we are seeing a lot of stabbings and violence. i am questioning the whole policy where we seem to be moving away from getting people straight, getting them clean, getting them sober, getting them back into their lives, and instead getting them on different drugs. i just don't see a good result as a result of that policy. do you have any thoughts on that? dr. gupta: thank you, congressman. one thing i've realized in the last two decades is this is a brain disease, just like a lot of other diseases. the way that we need to treat that is as a disease of the brain. that includes making sure that we understand the disease better. we provide the fda-approved medications to help the person. people may have different ways of getting at the treatment, congressman. some people may do ok cold turkey. others may need the medicatio n for various amounts of time. we have to figure out how to give the help to people when and where they need it, because they may not be coming back. the next time they come back may be as a fatal overdose in my emergency room. that is why we have taken actions here to save lives first. part of that means getting people the help they need, figure out what works for them while not giving up on our research agenda. sen. lynch: i appreciate that, i do, but i'm telling you and trying to give you feedback. it is not working where i am, in the eighth congressional district of massachusetts. i have 10 cities and hundreds and hundreds of people altogether right next to the suboxone clinic, right next to the methadone clinic that are shooting up. they are shooting up five or six times a day. you know, it is just a bad situation. i've had to go down there and look for young people who have left their families and are now totally off the grid and addicted to fentanyl and methamphetamines. it is a sad state. you know, the general of medicine came out with an article last week -- the journal of medicine came out with an article last week, two weeks ago, that between 2019 to 2020 the adolescent death rate has gone up 100%. it doubled in one year. i just think we are pushing more of this stuff out. it is not helping. i think we have to reassess. one last question. i am also on the transportation committee and i had an unclassified briefing with the department of homeland security and the faa. they tell me, and this is on judicial watch as well, we had 9000 unauthorized drone incursions over the southwest border last year. 9000. i'm just wondering, these drones have a payload of anywhere from 3, 5, 8 pounds. i'm sure a lot of fentanyl is coming over the border by drone and not by individuals, but they are shipping it in. i am wondering, i know the number of interventions has increased, but i worry about volume. is there more volume coming over? do you have more thoughts on that? sen. maloney: expired, but the doctor may answer your question. dr. gupta: it is tragic, congressman, and we are willing to work with you and congress in any way possible to help americans. on the second part, that is exactly the challenge of the 21st century. the tools and technology we need to be deterrence to these air drones, marine drones, some of these subterranean tunnels that i've been inside of, we need to work collectively to have deterrent technologies of the future because our adversaries are not waiting for us to develop them to fight this. i look forward to working with congress on some of those aspects, which the bad guys figure out one way or another to bring drugs in. sen. lynch: i look forward to working with you as well. i yelled back. sen. maloney: representative cloud, you are now recognized. rep. cloud: i have a few quick questions that should be easy. how many fentanyl have there been in the last year? dr. gupta: about 80,000. sen. cloud: we know the majority of that is coming over the southern border. where is the cartel sourcing it from, the fentanyl or components to make it? dr. gupta: predominantly china. sen. cloud: if china were to send over some bomb or chemical warfare that killed 70,001 hundred thousand people in our country, with that be an act of war -- 70,000 to 100,000 people in our country, would that being an act of war? dr. gupta: we are trying to understand the importance of cooperation in this area. sen. cloud: if they sent that many people over with guns that killed 70,000 to 80,000 people, would that be considered an invasion? dr. gupta: dearly people are dying already from fentanyl -- clearly people are dying already from fentanyl. sen. cloud: we have gone from the coyotes on the second side of the border who would hide until border patrol would move their post and then they would try to sneak people and drugs across.now the coyotes are armed sometimes better than our border patrol agents and our border patrol agents are told to stand down. no they bring their loads to the cartel and get them to station for processing. this is a backwards approach to border security. the chair at the beginning of the hearing tried to make some benefit to make it sound good that we are catching more fentanyl at the border. that's a ridiculous notion and a spin on bad news. we are catching more because there's more coming across, not that we are catching more of a percentage. almost half a million got away not to mention the ones we know we are not catching. the cartels are wreaking havoc on our nation while this nation stands down. you're wanting more money from us to fix this issue, but my question is we have sent you money to secure the border, the biden administration. how do we know that if we send you money for anything you are going to use it for what you are legally obligated to use it for? why should congress trust the biden administration at this point? dr. gupta: when i talk to individual agents and leaders at customs and border protection and federal agencies and look at the technologies that are enhanced, the infrastructure and people that could be enhanced, all of the deterrent and detection technology that could be enhanced, that is the rationale. sen. cloud: we have already paid, in congress, we have authorized and paid for much more border infrastructure and technologies to be put into place and the biden administration refuses to pay more than what it would take to put the wall up than what it would take to take it down resting in a stockpile. we are turning mexico into a narco state because of our inaction on the border and they're having a foothold and taking over communities in the united states of america. i don't understand how the biden administration makes any sort of positive news out of this. dr. gupta: i went to the wall in san pedro, and i walked 10 meters to the united states and i went down several feet into a drug smuggling tunnel coming from across the border. there were hundreds of those. they are constantly bringing men and women off the border patrol to seize and provide medication to those tunnels. we need cooperation from the mexicans to do that on their end. sen. cloud: they are coming in drones. the wall that we have already paid for that the administration is breaking the law not to build, we have paid for and given the direction to do it, their job is to execute the laws of the land and they are not executing. there is no way around that. they need to execute the laws of the land as sworn to do, as you have sworn to do, as biden has sworn to do, and harris has sworn to do. a lot of this is being bought by young people over tiktok. cartels are recruiting over tiktok to make transports and that sort of thing. social media as well. the big tech and social media companies then are pretty effective at clamping down on ideologies they don't believed be effective. what is getting them to disallow cartel activity on their platforms? dr. gupta: several conversations with big tech companies. we are working at the office. the cdc is working to make sure big tech is taking its own accountability and place. the dea is providing the one token killed campaign through a variety of mechanisms, including social media. clearly there is more that we need to do. why? we still have kids often times, but others as well, who don't often understand the importance of counterfeit pills these days. but the conversation and work is ongoing. i have been personally engaged and involved in some of those conversations and actions. sen. cloud: i yield back. sen. maloney: representative raskin, you are recognized. sen. raskin: dr. gupta, addiction is a terrible brain disease, as you have described it. i believe the administration has adopted an approach called harm reduction of trying to help people recover from addiction and trying to reduce the other legal harms -- lethal harms. can you explain, what is the overall theory behind harm reduction? what are the components of it? how is it working now? dr. gupta: thank you, congressman. over my 25 years what i have seen often is the only time i would see someone is when they are dead in my emergency room. i would often see them reversing and they go away. where people are using drugs, we are not there. where we are in the doctor's offices and hospitals, they are not there because there is a lack of trust and understanding. the idea of harm reduction is to meet people where they are, engage them, and build trust. what studies have shown is that these strategies allow more people to enter into treatment and allows more people to be saved, in terms of saving their life, and it is cost-effective. the administration is embracing proven strategies like naloxone, the antidote, making sure people get the antidote for opioid overdose. because we talk about counterfeit drugs that are in the community now, we are looking at how do you get people to help to check their own drugs to make sure that they are not playing russian roulette each time they use those drugs. lastly, the student service program that helps us prevent the spread of dangerous, fatal, and lifelong diseases like hiv and hepatitis. we have gone through an epidemic and we know what an outbreak of hepatitis and hiv looks like and a proven strategy to prevent that from happening. the goal is making sure we are saving lives first and foremost, and then obviously engaging individuals. sen. raskin: you have a policy that most of the states and local governments are participating in along with the federal government? dr. gupta: yes, it has bipartisan support and it is one that has been adopted by many states and local governments and has, as a result, saved lives. sen. raskin: well, how do you envision the role of the national government going forward in expanding access to harm reduction services? obviously we are in the thick of this terrible crisis. our people are suffering, and more and more people are getting addicted. how can the federal government become an instrument of actually getting assistance to our people who need it? dr. gupta: harm reduction policies, we as a provider at a local health division i can tell you is about building community trust and bringing partners together, including law enforcement, to build that trust. the federal government and congress can provide the resources needed for communities to be able to, on a voluntary basis, and the ability to heal the community through building trust through connecting people back with treatment and offering resources that they need to move forward. we have too many broken communities across the nation because of this crisis, and this is another opportunity to do that with resources of course with congress. sen. raskin: i will yield back, madam chair. sen. maloney: mr. grossman, you are recognized. sen. grothman: can you hear me? in 2020 6000 people crossed the border. most recently 103,000. 6000 in april to 182,000. do you feel that is a complete and total embarrassment? how would you describe that performance and what we are discussing today? 6000 to 180,000? dr. gupta: i'm having difficulty hearing you. i believe you were comparing numbers? sen. grothman: 6000 people crossed the border into the united states in april of 2020. that number was 183,000. do you consider that a complete embarrassment and you think we need to do something -- dr. gupta: thank you, congressman. i believe obviously we are concerned about the amount of fentanyl and other drugs that are trafficked across the nation globally. one of the things that i think it's really important for us and for us to not lose sight of is where the drugs are coming from, how they are being manufactured, and obviously what is happening to the american people falling victim. sen. grothman: 6000 to 183,000, does that bother you? dr. gupta: congressman, clearly it is important that we have a robust border, and i do believe to the extent that our men and women are doing their job, they are doing their job and we need to provide them the resources. sen. grothman: the system to which under the rules they operated under two years ago 6000 people were busted instead of 183,000? dr. gupta: frankly, congressman, i would prefer to go to a place where we did not have literally any overdose deaths. we have too many overdose deaths, over one million americans have died. sen. grothman: you don't want to answer that. given the huge number of deaths, 110,000 from illegal drugs and 12 months, do you feel more people now should be put in prison for selling or trafficking these drugs, fentanyl in particular? dr. gupta: i believe that people who are trafficking, manufacturing, and routing these drugs for the sole -- for the sole purpose of profit need to be held accountable. sen. grothman: you think more people should be going to prison for trafficking or selling fentanyl? dr. gupta: i feel that people should be accountable for their actions. of course, we have the most lethal drug supply we have had in this nation's history. sen. grothman: if we had to do last year over, do you feel more people should be going to prison than now for 110,000 deaths? dr. gupta: congressman, i think the responsible pupil should be -- sen. grothman: next question. do you know the total number of professionals dealing with addiction and that sort of thing has -- can you give an estimate to the number of people making their living as addiction professionals? dr. gupta: i can tell you that we have significant shortages of professionals for addiction medicine. sen. grothman: can you answer one of my questions? the total number of people working in this field today compared to 10 years ago? dr. gupta: i can get the figures for you, congressman. i do know that we have significant shortages, but i can get you exact numbers. we had significant turnover during the pandemic as well. sen. grothman: next question. [indiscernible] -- people who die or are convicted for selling these drugs family -- dr. gupta: family background? sen. grothman: family structure. family structure. no father at home. no mom and dad at home. no parents at home? sen. maloney: the gentleman's time has expired. representative kelly, you are recognized. sen. kelly: thank you, madam chair. the biden administration is committed to a health equity approach to addressing substance abuse disorders and recognizes people have been unable to obtain treatment simply because they experience low income or live in a community lacking adequate recovery resources. president biden's national drug control strategy aims to address the systemic health disparities that previous administrations have ignored. director gupta i understand there is a link between unemployment and experiencing substance abuse disorders. how has the administration been addressing this and other root causes? dr. gupta: thank you, congresswoman. i believe this administration looks at the underlying factors. it is important to understand childhood experiences matter, we call them adverse childhood events and experiences. it is important that we know from this data that someone who has these types of events, five or more, has almost tenfold increase of using illicit drugs. also, overall, lack of education, less likely to have or hold a job. these things are connected. when we look at the underlying factors, things like housing, jobs, economic security, food security, all of those aspects are important to a person's not only survival but thriving. it is important for us as we work with other agencies like hud, transportation, or others to make sure that we are looking at the entirety of the picture of communities and addressing it from that perspective as well. sen. kelly: i was going to ask how the administration plans to utilize preventive methods to specifically address the social determinants of health? dr. gupta: thank you. one of the things that we want to be able to do as the president has announced and taken leadership on is to make sure that people have the housing they need, especially in the area of substance abuse disorders. it's critical. the same thing goes for food security. it goes for economics. it goes for deflection, to get people help instead of incarcerating them. those aspects are part of the strategy and allow us to build a more resilient population while making sure we are focusing on primary prevention for school-aged children as well to have a more robust future america, which is a really important part of this strategy. sen. kelly: can you cite any improve -- i know you've only been around not quite to years -- but any improvements, any consequences of your work already in ensuring equity when addressing treatments for opioid use disorder? have you seen any pattern changes by using your strategy? dr. gupta: we clearly are seeing, as i mentioned two weeks ago, the cdc for the first time demonstrated a 12 month pattern with fewer deaths than the past report a month ago. it is a very small amount of change. we are hoping and expecting that as we continue this effort it will help more. we are working with the department of education have information disseminated to school districts around prevention messages. it is the president's committed to ensuring that equity is something we are looking at carefully, because we are seeing for the first time some of the highest rises in overdose deaths in african-american populations, especially black males. the worst problem is we know some populations have the most difficulty entering treatment. we are trying to narrow those gaps to make sure that we are at the end of the day saving lives. sen. kelly: further research and methodologies surrounding the social determinants of health is something the administration is prioritizing? dr. gupta: yes, congresswoman. it is something we are making sure that we are looking into. the research, not just what is, but what are those differences. how can we make it better? we are also looking at prevention and treatment aspects that can help us get to a place where fewer americans are using drugs and fewer americans are ultimately dying. sen. kelly: i want to say that we cannot fully address substance abuse disorder without first addressing the true causes and ensuring that marginalized communities receive the support that they need. thank you. i yield back. sen. maloney: you are recognized. >> thank you for being here. last month during a traffic stop police in pennell county, not a border county but in my state, stopped two women for speeding. they found 500,000 fentanyl pills last month. 500,000. synthetic opioid deaths including fentanyl up 23% from last year. cocaine deaths of 23% from last year. myth and other stimulants up from last year. arizona, in two months from the end of last year, seized more than 3 million fentanyl pills. madam chair, i asked that this article be put into the record. sen. maloney: without objection. >> thank you. dr. gupta two weeks ago they found 55 pounds of fentanyl stuck in a gas tank coming across the border. hallelujah, they are stopping some. 2018, pennell county, zero fentanyl pills. 2019, 700. 2020, 200,000 plus fentanyl pills. 2021, more than 1.1 million fentanyl pills in that county alone. in your written testimony you say the united states has a fundamental responsibility to protect its borders and this is what the biden administration has been doing. two months ago secretary mallorca testified they had operational control over the border. are you familiar with the secure fence act of 2006? dr. gupta: i am aware of it. sen. biggs: here's how they define operational control. "the prevention of all unlawful u.s. entries including entries by terrorists, other unlawful aliens, and instruments of terrorism, narcotics, and other contraband." you wouldn't say that our borders operationally secure knowing the amount of narcotics coming across? dr. gupta: what i would say is that our border is secure but there is more we can do. sen. biggs: you are saying the border is secure? that undermines the credibility. you say approximately 92% of the heroin seized in the u.s. is from mexico, 92% of the drugs coming from over the southern border. that is not operational control. according to the dea, 42% of pills tested for fentanyl contained a lethal dose. in the texas ports of entry they saw a 1000% increase in seized fentanyl. you say that's a great sign and it's good we are stopping some of it, but the president of the national border patrol council testified under oath this year that cdp is likely if they seize 5% of what is coming over the border -- lucky if they seize 5% of what is coming over the border will stop you understand what i'm saying? the ratio indicates we are failing. yet you tell us that the border is secure. you say that you have visited the border into places. -- in two places. i would love for you to come with me, you and me incognito. we will tell them that you are the executive -- director of the national drug policy, we won't tell them that. come down to the border and i will take you places where you can watch what is happening. you can watch our men and women overrun. there are literally hundreds of miles unprotected, which is where drugs are coming in. we will find a place, we will watch people come across in camo with backpacks on carrying drugs. i will do that with you. when you say we want interdiction materials, high-tech, all of that, fantastic, but when you talk to border patrol agents and we will talk to real border patrol agents and managers who will tell you if they don't know who you are and they can trust you what is going on. they will say we may need more resources, but what we really need is the policy so that we can enforce the law to secure our borders. as long as we fail to do it we will continue this rather inhumane approach to the border. you have drug trafficking, human smuggling, human trafficking coming across. you have people like the lady who was wandering around in the desert found by some sheriffs deputies about two months ago. why are you carrying those pills? they are morning-after pills because i knew that i would be raped repeatedly coming across. it is incumbent on you before you can solve the problem you're trying to solve, and i appreciate your trying to take a multifaceted approach and it is a huge task. i don't envy you the task, but as long as you are in denial of what is happening on the border you will not solve the biggest part of this, the smuggling. i do extend to you an invitation to come with me to the border. i often. i go to a lot of places and i would love to have you with me. sen. maloney: representative wasserman schultz, you are recognized. sen. wasserman schultz: thank you for your testimony and efforts to combat this. i would say for the record that your efforts are from not understanding what the crisis is. my experience with you and the conversations i've had with you, it is clear to me that you understand the depth of the crisis. it is also clear to me that immigration policy and border policy is not in your job description. our colleagues on the others of the aisle talk a good game about focusing on what we are actually responsible for. that policy is not what we are responsible for in the oversight committee.i want to talk about an issue that affects my home state of florida and states that have not expanded medicaid, how inadequate coverage contributes to the overdose crisis. overdose deaths are lower where medicaid has been expanded under the affordable care act. they experience at least 10% fewer overdoses of synthetic opioids like fentanyl and 11% fewer involving heroin compared to states who have not expanded medicaid. how does medicaid expansion combat opioid epidemic and expand treatment for individuals experiencing substance abuse disorder? dr. gupta: thank you. i appreciate the efforts and of the fact that we were able to see some offloads once again of the interdiction. it is important. the treatment part is so critical, because as we try to get people to help, one of the reasons people don't get the help is because they don't have the coverage and they cannot afford it. very few people we are trying to help cannot afford to see a physician or provider, and that is tragic and unfortunate. we know there is a direct link between increasing access to care and getting actually the care. it is critical. that is probably one of the most important pieces of the backbone that we would need to solve this crisis and save the 170,000 lives. access to care is a critical component. obviously people who get it are able to have one more issue they don't have to worry about while seeking care. sen. wasserman schultz: absolutely. we are all painfully aware of the addiction and overdose crisis and how it has impacted our nation's young people. the final two years of the trump administration the overdose mortality rate against adolescence went up 94%. this crisis affects young adults who may struggle to find adequate health insurance. let me tell you, you and i together saw firsthand the efforts being made with an entire deck full of interdicted drugs in south florida that were brought in among one of the largest interdiction's of drugs in our history that the coast guard was able to recover. you and i were there to witness it. any suggestion that there is not every effort being made to interdict the smuggling of illicit drugs is erroneous. i want to focus on medicaid expansion and how it would help young adults acquire health insurance. how would increased access to health insurance lead to access to effective treatment and recovery and improved outcomes for young adults and society generally? we have 12 states in the country, mine included, that have not expanded medicaid. as a result the rates of drug overdose are higher and no states then and is in those states that have expanded medicaid. dr. gupta: >> thank you, congresswoman. first of all, it's important to note that about half of the people with the disorder has mental health and vice versa and it's the important of access to care. it's true and tragic that young people are perishing at a higher rate than ever before because of the overlap of the two. and it's also true that the majority of the people of the 107,000 deaths that happened between 55 and 64 years of age and working age that we're losing 100,000 people at a time every year, and if you think about it from economics, come on sense, think about it from the people to get the ability that they can get help and overlap, it's critical. >> it's basic math. what it boils down to. if you can afford to pay for your health care, you're much more likely to be able to get access to that care and prevent your-- ever being with drugs in the first place and drugs in the second place. i appreciate your explanation how medicaid is vital in your fight. and to fight addiction and overdoses, yet republicans like florida governor ron desantis refuse to expand medicaid for the abuse and misery that brings in. governor desantis it from the shame and overwhelming grief that families must endure because of his callus reactions, and we don't stop calling out his and other republicans, and that those suffer. and dr. gupta thank you search for your service. >> thank you. yields back. and representative, you're now recognized. >> thank you, madam chair, dr. gupta, according to the dea, the illegal smuggling of narcotics in our country increased dramatically over the last few years. do you agree with the dea's assessment that smuggling of cocaine and methamphetamines and fentanyl is on the rise? >> congressman, we are seeing unprecedented environment that this country has never seen before. >> okay. >> and i thought it was interesting, too, doctor, that the dea says the only major drug that's actually on the decline as far as illegal smuggling is heroin, but it's only because fentanyl has replace r placed it because it's cheaper and easier and greater profits and a lot deadlier. doctor, is it accurate to say that fentanyl is, i think it's 50 times more powerful than heroin and 100 times more powerful than morphine, is that accurate? >> congressman, that would be accurate. i just want today mention one thing that we're seeing a transition from plant-based organic compound like heroin to synthetics and a pandora's box has been opened with the lab production of synthetics like fentanyl. >> okay. and i think this is important and from your testimony, from a prior, one of my colleagues, but the country that the lion's share of these drugs are being smuggled from and into our country is which country again? >> obviously where they're being produced is mexico, but obviously, other nations like china, from which they're coming from. >> so is it fair to say most of the methamphetamine in the country is produced in mexico and most of the fentanyl is produced in china, but i also heard from some of our dea agents that fentanyl production in mexico is also on the rise. is that accurate? >> congressman, as of today, for most of america or for the united states, actually, the precursors shipped predominantly for china and primarily meth happens in mexico and americans bear the burden. >> you can understand my concern when you have 107,000 deaths, american deaths, to drug overdoses mostly opioids and i think you said 85,000 for fentanyl alone, and my home state, 1,054 mile border with mexico which has proven time and again to be a defacto narco state and here we have the worst record, the worst on record for illegal encounters was april with 234,000, but that was broken in may with nearly 240,000 illegal border crossings. and during the biden administration, 2.9 million illegal border encounters in just 700,000 got-aways. that's at least 3.6 million and if only 1% of those folks crossing the border are smuggling narcotics, even small amounts, that's 36,000 times, that's remarkable. so here are some stats. the customs and border patrol that estimates during the biden administration over million pound of illegal narcotics have been seized along the border. and 7,000 pound of meant fentanyl, enough to kill every american times over. and secretary mayorkas said the border was secure and operational control and i was a little surprised an and i think my colleague, representative biggs, did an outstanding job in questioning. again, your testimony is that director of the national drug control policy for the biden administration, that our border is secure, is that correct? because that's what you said to him. >> thank you, congressman. we believe certainly that the border is secure with respect to making sure that we are seizing both the drugs, but also the counter narcotics aspect we're partnering closely with mexico to ensure that because the problems do not begin or end at the border when they're concerned with narcotics and other illegal drugs. we want to make sure we're addressing the causes of production, the causes of transportation, the routes, as well as shipments from china. >> and doctor, i apologize, i have to reclaim my time only because i have five minutes. i'm shocked. i think that's shockingly inaccurate and -- i mean, of course, one of the dangerous border and the mexican drug cartel, the fact of the matter is controlling our southern border not our federal government and it's a gross dereliction of duty that are putting americans at risk and folks in droves, coming to the republican party because they're sick of the corruption, chaos and the crime. and madam chair, thanks very much. i'll lead back. >> and to follow up with the discussion we had i'd like unanimous consent to enter president biden's 2020 executive order imposing sanctions on transnational cartels and drug traffickers, just, the administration has extradited 10 transnational criminals from mexico to the u.s. including several top cartel operatives and sanctioned another 26 operatives and 10 trafficking organizations. so, the truth is the biden administration has been aggressively going after the cartels. now i would like-- and unanimous consent to place it in the record. without objection. now, congressman ro khanna, you're now recognized. thank you, madam chair and thank you for your leadership. it's clear that the statler family and purdue pharma, along with other pharmacies are possibly for massive crime on the american families and the harm with the opioid epidemic and they need to be held accountable. they shouldn't be able to hide behind bankruptcy court or shield their assets of the crimes they've committed on the american public. and the focus on the current research that shows that cannabis can be a key alternative to opioids, when it comes to relieving pain. access to cannabis is associated with the reduced rates of opioid use and abuse. opioid reduce rates of opioid-related hospitalizations, reduce rates of opioid related traffic facilities. and drug treatment admissions. one study showed 64% of opioid use, and those using marijuana. doctor, i appreciate that you and the administration are aware of the study, is that true? >> thank you, congressman, we are closely monitoring these as someone who has implemented a medical cannabis in the state of west virginia. i understand this work and we're monitoring those studies as well. >> thank you, dr. gupta. would you say based on your experience that it's true to cannabis use is an effective alternative for chronic pain in patients? >> there is evident to suggest that in cases of certain chronic pain and cannabis can be -- can be application. >> when it comes to acute pain, what category do opioid prescriptions fall under? >> do you know? or i can let now if you don't. >> most prescriptions are class two. >> exactly, exactly, schedule two and yet cannabis is still categorized as a schedule one drug, which is the most heavily restricted category, which prohibits scientists and researchers from conducting rigorous, large scale studies on cannabis. just to be clear, this means that cannabis is more restrictive policies than currently opioids have. opioids have killed tens of thousands of americans. do you see this, dr. gupta, as a contradiction that needs to be resolved? >> thank you, congressman. clearly, the president has been clear about this with regards to the -- it's important for us to continue to look at this and from a research perspective, from a medical use perspective, but it's clearly the policies that we've had in this country with regards to marijuana have not worked and that the president has said so. >> i appreciate that, doctor. i admire your public service and you have to be careful not to get ahead of the president if you're appropriately diplomatic in your responses, but i just, the president has the executive authority for the dea, hhs and f.d.a. for administratively rescheduling marijuana and facilitate patient access. i'm for legalizing at the least, decriminalizing and the president could make sure that at least reschedule, if not more restrictive than opioids themselves. dr. gupta, you don't have to make public comments. can you assure the committee today that privately, at the very least, you will urge the president and the administration to follow the best judgment of science here and medical research because that can really help in solving this problem? >> thank you, congressman. i think it's the foundation for so many ways to proceed forward, including the current strategy is to follow science, follow data and i can commit to you to do that. >> thank you. and i just would hope that you and the administration really will consider the rescheduling and a look at what can make the difference in patient's lives and resolve that discrepancy, where currently cannabis, it's more effective and it's more restrictive than the opioids that have done so much harm in american life and i appreciate your public service and i appropriate your work and thank you for appearing before this committee. >> all right. the gentleman yields back. representative donald, you're now called upon. representative donald. thank you, madam chair. dr. gupta, thank you for joining us. quick question, were you talking about transportation of fentanyl and other opioids, routes, manufacturing, you mentioned that there's precursor that comes from china. wouldn't you say that most of the actual pills that are fentanyl are manufactured in mexico? >> congressman, yes, they are manufactured in mexico after production. >> so they're manufactured in mexico and where do they go from there? >> they are often trafficked. we know that they are-- they end up in the hand of unsuspecting americans, often times. >> how are they trafficked into the united states, dr. gupta? >> well, we understand they're trafficked across all routes from land borders, sea border, ports of entry, air, so there's-- >> dr. gupta, i have a question. it's a question on the point of tracking itself. wouldn't you say would be better for border patrol agents to be fully focused on the traffic of narcotics, as opposed to processing people coming across the border at an illegal point of entry? >> congressman, i think you're trying to get to the point of resources, i guess, and the fact of the matter is that we have to be able to do both, but when it comes to counter narcotics. >> dr. gupta, your point about resources, resources finite, only, but so many resources at your disposal. we know there are only so many men and women of border patrol at the disposal. united states. would it be more effective drug policy to have border patrol agents monitoring drug trafficking than processing people with asylum applications that are coming to an illegal point of entry? >> congressman, what i would say to you is it is a dissolution of resources, the president has asked for a budget to match that, but we must look at the profits that are driving the transnational criminal organization. i say this it's not only drug, it's a poly crime organization, snug smuggling people, smuggling drugs, smuggling cash. >> and i agree with what you're saying, they're smuggling, people, drugs, cash and weapons. what you just alluded isn't the best policy for the white house and definitely with your respect within the purview of the administration to make sure that border agents are focused on trafficking of all of these things as opposed to processing people at the southern border, let me add this point to my question. fine point, i've been there four times, the president has not been, but of' been there four time. when a border agent is at the southern border and a group of people come out of the brush crossing our border illegally, the border agent usually by himself or herself has to stop actually patrolling the section they are responsible for, and they have to go through the process of doing intake of everybody that approached them. i was at a border stop where people came across illegally about a week ago in texas and i watched that firsthand and that agent is distracted. at that time when the agent had to deal with people across the border illegally. on the radio there were runners coming through the section who did not want to give themselves up and i assume they were running with narcotics, namely fentanyl. so the original point of question, isn't it better policy in the united states for border agents to be focused on trafficking from the drug cartels and multinational criminal organizations as opposed to actually going through the process of processing people coming into our country at an illegal point of entry? >> i hope we can do both and i hope we can do both because what drives-- >> and the strategy dr. gupta, hope is not a strategy, hope is wishful thinking. you already dictated finite resources and so many border agents, if you have to choose, which do you choose, dr. gupta. >> if we follow the strategy laid out, the president's strategy, drug control strategy, i think you will find a number of technological aspects to both the detection and deterrents, allow us to save money by using technology for na, but we must go after the profits of these transnational criminal organizations. >> i completely agree with you, dr. gupta, i'm going to reclaim my time. to go after their profit we stop processing people at an illegal point of entry, because then they won't pay the drug cartels, for profit, to traffic them into the united states. the drug cartels are using human trafficking into our country as a way to actually increase drug trafficking into our country. >> the gentleman's time has expired. >> and with the amount of fentanyl deaths in the united states. and thank you for your indulgence, i yield back my time. >> representative, you're recognized. >> thank you, madam chair and thank you, doctor for being here and thank you for your lifetime work in this field. i wanted to talk to you a little about, and very much appreciate the evidence-based approach. we've had success in a bipartisan way on criminal justice reform. we've had people like -- agreed that evidence-based research policies can work and they're effective and they clearly work when it comes to substance abuse. 30 million americans who have substance abuse problems, almost 70% of them say they're either in recovery or have recovered. for those of us who are familiar with recovery, this is certainly an argument to be made you're always in recovery once you have become addicted. one of my frustrations, doctor, is, i'm sure yours as well. the scale of this country, your institution, i was at a -- at an event this sunday for sober living, nonprofit i've been involved with since i was with the local government for 30 years, myself and the presiding judge of our drug court, a republican nominee and we were talking about, ironically, the last comments about health. and the hope of having programs like that at a community level, where users and families, users of services, addicted people, can see them work because of the evidence-based research. so the frustration is getting the federal government to be in a role of-- from my perspective, identifying those programs that work, and then incentivizing investments in those programs at a community level. can you speak to that, both your frustrations and successes. i look at places like johns hopkins and i see this, and where there are exponential research and understanding of addiction and neuroscience is so wonderful, but then deploying that to the communities that need it are so frustrating. >> thank you, congressman. i think it's an important piece to understand at least two-thirds of people that are incarcerated have a diagnosis of substitute disorder or addiction and therefore, it's important, first of all, to think about all the programs that could do a free arrest like a deflection program we've put out a state model loss that tried to get people both with public safety and public health communities to work together. to get people to help the needs and with the incarceration. it's common sense. second, drug courts, we want to make sure that before either the diversion, drug courts and like that, we have robust training ensuring that people have the opportunity for nonviolent crime to have, to move on and make sure that happens. treatment for people incarcerated is critical and we're doing that because people become more productive, and the death rates decline significantly, and seen in states like rhode island when we could treat people. and recidivism and. costs go down as well and reentry, it's important to make sure that when people are ready to re-enter society we get them the tools we need to be successful and that's when the treatment and community connection become important and then recovery support services, understanding that recovery is not about treatment only, but about all the support that individuals need with their help, with their home, with their community and purpose in life to make sure that they have all of those surrounding services and supports to make them successful across a lifetime. >> and let's follow up on that, having had multiple discussions with secretary walsh and the further education and labor committee and ensure that health employment labor and the attention of the subcommittee and with jaffier becerra. years ago i had a conversation with legislature dealing with criminal justice reform, that's been successful here in california, and aca, i have the warden of san quentin tell me why are you surprised we release people back here into your district in richmond, back into oakland and they're back in a month, give them $200 and good luck. how are we coordinating services at the federal and state level? >> at a travel level, congressman, it's important for us to be working together and that's what they come in with the strategy. it allows us to work with health and human services, making sure that we have both recovery ready work force as well, but also recovery ready employers, and employment places that allow that to happen. so it's a matter of coordination and that's exactly what we're doing by bringing the drug control agencies together ap work on it collectively. the state level, i'm proud of when i talk to leaders like governor sununu in new hampshire, leading the recovery work force and recovery ready workplaces and i visited him and happy to see when we decide it's the right thing to do because it makes sense and there are governors across the state, across the country that are actually moving to understand it's a cost effective, with 23 million americans, 23 million americans at the present called out on the speech that are on path to recovery. we need to support them and do everything we can to provide them the resources. >> thank you, doctor. public health is public safety. right? i yield back. >> thank you. >> representative, you're now recognized. >> thank you, madam chair. dr. gupta, is fentanyl the deadliest drug currently coming across the border? >> congressman, there are some others, but predominantly, it is. >> and is fentanyl being manufactured in clan destine labs on the mexican side of the border? >> yes, congressman. >> and when they are manufacturing these synthetic opioids, where are they obtaining the precursor chemicals from? >> mostly from china. >> what is this administration doing to hold china accountable for helping the cartels create fentanyl? >> congressman, i agree with the words of secretary blinken, who spoke recently about china policy, which is that we have to work with the prc to make sure that the criminal elements within the prc are held to account and if china is the global leader and demonstrates the leadership that it must actually hold accountable. so one of the things we're doing are working closely with our ambassador, nick burns, in beijing to see how we work together and we have very specific asks of the people's republic of china and we've provided them the ask, both in meetings as well as in writing, that means those asks are that we want you to make sure that there is labeling and you're following the uniform international shipping standards. we want you to make sure that your customer, all the way to the end users and making sure dual use chemicals, we're keeping track what to do that. >> let me reclaim my time there, you know, we obviously don't feel that that's a firm stance with china. we all know from history, china is not the most truthful country we deal with. they stealing intellectual property, they're contributing to the fentanyl crisis we have here in america. back to the mexican drug cartels, they smuggle both people and drugs in their operations, correct? >> correct. >> are the cartels using their human smuggling operations to facilitate their drug smuggling operation? >> we believe sometimes they are and sometimes they're not. depends reasons for both. >> i can tell you in the region you've had so many questions, the republicans on that committee we've been to the border numerous times and the drug cartels tell us that, in fact, that drug cartels use human smugglers to get their fentanyl across the border. so, my question, sir, why was the southern border only mentioned twice in the national drug control strategy for 2022? >> congressman, my point to you, there's an entire responsibility to provide border strategy so there's accompanying documents that focuses just on the border strategy, the southwest border, the caribbean border and northern border, there's an entire complement that have the border strategies, the full written complement. >> dr. gupta, we've been at this question by many republicans on the committee and i'm going to give you one last opportunity to answer the question since i'm the last questioner and remind you, you are under oath, but do you believe the biden administration is doing everything it can to control the illicit flow of fentanyl across the southern border? >> congressman, i believe we can do more and i think we need to do more, and i believe part of that requires making sure that we're holding mexico to-- and mexican government accountable with the same level of energy, enthusiasm that we are working on gun trafficking, cash trafficking and we want them to act accordingly and as robust as we are because we've put a lot of resources into mexico. we can do more in terms of the budget and congress making sure that folks have the technology and resources as well as infrastructure. we can do more to stop the shipment of precursors from china and make sure the next country in the line does not substitute for that. >> and i'll close with this, my time is about up. you know, there aren't many areas right now, unfortunately, where there's bipartisan agreement in congress, there's one agreement that the fentanyl is coming across the southern border and this administration needs to do more. when you ask for more funding, when we talk to the border patrol, they say that this administration continues to do things to tie their hands, like the recent announcement just title 42, that's only making illegal border crossings significantly increase. when the border crossing increases, there's more drugs that go across the border. >> the time expired. >> this administration is going to have to get serious. >> madam chair i'll wrap it up, you can't have a committee on the national drug control strategy and the federal response without addressing the crisis at the southern border and that's what we have is a crisis and this administration's response is substandard and only make ago bad situation worse, i'll yield back. >> the representative yields back and representative, you're recognized. >> thank you, madam chairman. i know addiction is a critical issue even as my colleague focus so much on some of the border and immigration policies, i know within our own country we just have not done enough to push back and understand-- or push back on this rhetoric that we don't have a substance abuse issue and problem in our country. especially with even some, you know, legal pharmaceutical companies pushing, you know the opioid -- contributing to the opioid crisis right here at home and many of my colleagues continue to actually benefit through political contributions from some of the same folks that continue to push those drugs onto our families. you know, one of the things i want to talk about is that, you know, expanding access to an opiate overdose, narcan, saving tens of thousands of lives as you know, doctor. we've seen in places like massachusetts where narcan distribution program reduced opioid overdoses and deaths by an estimated 11% without increasing opiate use, if i may, chairwoman, i'd like to submit a study to show some impact of that program, that distribution program. >> without objection. >> thank you. to maximize the life saving of these treatments, it's imperative, you know, doctor, that the overdose medications are affordable and accessible in every city and town across the united states. doctor, how does the current administration's increase access to narcan so it can be readily available for people who need it the most, including those historically neglected communities like mine. you should know, seeing some of the information coming out i think the past decade over 2000 of my fellow detroiters lost their lives to this corporate, you know, corporate funded pushed you know addiction on them, of them 364 were overdose deaths in 2019. 86% of those deaths were involved opiates, what can you tell me you're doing to increase access. >> thank you, congresswoman. naloxone or narcan, this is about making sure it's affordable and it's accessible, and one of the things that we're doing, making sure that states have set aside amount to be able to put acquire, as well as have a distribution plan especially to the most vulnerable communities within the states to be able to distribute. it does no good sitting on the shelf because it's not saving lives, but we're intentional making sure that we are removing the affordability aspect of naloxone and providing naloxone in the hand of people who need it because we know if we do not, we are on track to have 153,000 deaths a year by 2025, but if we do what the strategy calls for, we can reduce that number literally by half to 81,000. if we accumulate over the next three years, we talk about hundreds of thousands of american lives that can be saved and naloxone is life saving, for every dollar there's a $2760 return investment the biggest bang for the buck in terms of saving lives and a critical aspect of the strategy. so, we're moving forward to make sure that we're working closely with hhs. with the other federal agencies and state partners as well as local partners. >> thank you so much. one. things as a parent i want to talk about is how do we have in some of our high school and universities and campuses? because i've been hearing, obviously, increase in addiction among our, you know, college age, i would say, and use and so anything that we're doing in that regard. >> thank you, congresswoman. it breaks my heart every time we see children, especially, die unknowingly, unsuspectedly because of the use of the counterfeit pill. it's important while we work on the supply side we make sure that our kids are aware. this is no different than learning cpr, having aed devices on the wall. removing the stigma and this is about saving a life and not making judgments. because we believe every life is precious and worth saving. >> absolutely. as i look at our country, if it's not this crisis of addiction, there's others in the future and we have to try to work on this holistically as well. thank you all so much and i yield, madam chair. >> thank you. before we close, i want to offer the ranking member an opportunity to offer any closing remarks he may have. ranking member, you're now recognized. >> thank you, madam chair, and dr. gupta, thank you for coming before this committee we appreciate your willingness to give us an update of what this administration is focused on with roux he inspect to drug control. i think you heard loud and clear that republicans are concerned with the lack of border security, along the southern border and we get this from many conversations with border patrol, and with local law enforcement. even in kentucky, in rural kentucky my drug task force agents tell me that all the fentanyl and all of the crystal meth which are the two main drugs of choice right now on the streets in rural kentucky, in rural america, for that matter, are coming across the southern border. so i don't think it's-- makes a lot of sense for this administration to say they're focused on drug control when we have a border that's wide open. and this administration continues to do things to tie the hand of our border agents by announcing that they're going to do things like suspend title 42. we need to get serious about the border and we need to hold mexico and china accountable for the drugs that they're working together to manufacture in mexico with input from china, that they're sending across the border and i think that we can do that, but this administration is going to have to take this seriously and greatly reverse course with respect to border security on the southern border. with that, madam chair, i yield back and thank you again for holding this hearing. >> thank you for participating, and i thank our panelists and all of my colleagues for participating. before i get to my closing statement it's clear we need a comprehensive approach to this crisis. i would like to enter into the record a customs and border protection study showing that as of 2019, 90% of heroin and 80% of-- >> we'll leave the last few minutes of this house hearing for a live update on the federal government's pandemic response efforts being held by the white house covid-19 response team. >> dr. walensky, after i speak

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