To access. These affect to these effective medications resulting in a significant Addiction Treatment gap in our country. This is without question a chronic neurobiological disorder that starts with a genetic risk, is informed by the environment, and is solidified by the culture surrounding it. Not unlike diabetes or hypertension, we can effectively manage the disease but stopping that treatment prematurely costs us lives. Were here today to provide recommendations on how best to respond to the epidemic of prescription opioid and heroin misuse, addiction and related Overdose Deaths. According to the centers for disease control, we have reached epidemic levels in our country. Weve all seen the data and heard the shocking statistics. But whats not said or heard enough is that the 2. 3 Million People who need treatment for opioid addiction have a chronic disease of the brain. While we need to prevent other americans from developing addiction, these 2. 3 Million People need treatment now. There are currently three medications that are fda approved to treat opioid addiction. Methadone which has been used in highly regulated Opioid Treatment Program since the 1960s. Its been used since 2002 by physicians who complete a special training in their offices and now trexone that can be administered by any licenses prescriber. All of these medications have proven tore clinically effective. A 2013 review of the scientific literature found substantial broad and conclusive evidence for the effectiveness of all three medications. And for methadone in particular. Notably the literature on efficacy of these medications is not new. There are now eight largescale rigorously conducted reviews of the literature on these medications since the early 80s. All fda medications have been shown to reduce mortality. Finally, we have a clear and comprehensive guideline for how to use these medications effectively in the Clinical Care of persons with addiction. However, despite the strong Evidence Base use of these medications and the clinical guidance available, very few eligible patients are offered medication to help treat their disease. Less than 30 of treatment programs offer medications in less than half of eligible patients in those programs receive medications. Indeed a study published this last week in the journal of the American Medical Association found that 80 of americans with opioid addiction dont receive treatment. This treatment gap is attributable to many factors, many some more complex than others. Research has demonstrated significant access barriers to methadone including waiting lists for treatment entry, limited geographic kovrm, limited insurance coverage, and the requirement that many patiented receive methadone daily. Data 2000 was intended to expand access to Addiction Treatment across geographies and populations by integrating it into the general medical setting. In recent months, my practice has had to turn away patients a due to the 100patient limit. And this includes pregnant patients as well as the children of my friends and has resulted in at least two Overdose Deaths that we can track. If i am out of town or unavailable, my fphysician assistants due to the restriction on pas and Nurse Practitioners writing it which exists even if they are under the guidance of a physician who is Board Certified in addiction. It is important to note that the entire purpose of data 2000 was to make opioid Addiction Treatment available outside an otp. And traditional physicians offices both to increase access in areas where otps may be physically inaccessible and to reduce the stigma and burden visiting for treatment on a daily basis. Still, because diversion and quality of care remain legitimate concerns, asam has proposed a gradual and limited lifting of the data 2,000 limits. But coupling with increased training requirements and accountability for those physicians treating large numbers of patients, we feel we can expand access while also ensuring a certain quality of care. Still, this single strategy should be just one part of a broader federal effort to ensure safe prescribing of opioids for pain, alternative pain therapy options and early identification and treatment of addiction. Pain and addiction education should be required curriculum in medical school and encouraged as continuing education throughout a physicians career. Communities should have the resources to educate their citizens about these issues and the outreach and surveillance resources necessary to better understand the unique issues and needs. Thank you again for the opportunity to present here today. Asam and myself look forward to a continued collaboration on this and other addictionrelated issues. The chair thanks the gentleman, now recognizes dr. Katz, five minutes for your summary. Epidemic confronting this nation has exploded in recent years due to the accessibility of cheaply made massproduced deadly synthetic drugs. As a physician on the front line, i have witnessed how these dangerous compounds have directly led to violence, hospitalizations and deaths. For example, in both the adult and pediatric expensive care units in allentown, pennsylvania, this spring, i spent countless hours at the bedside caring for patients suffering from synthetic marijuana which ripped through eastern pennsylvania leaving in its wake multiple patients in Emergency Departments, hospitals and unfortunately morgues. Mr. Chairman and members of the subcommittee, my name is dr. Kenneth katz and i am Board Certified in internal medicine. Thank you for allowing me to testify today on behalf of the American College of Emergency Physicians to discuss the dangers posed by synthetic drugs and to advocate for an act of hr 5353, the synthetic drug control act of 2015. In every Community Across the nation my colleagues and i are treating more and more patients of drug toxicity or poisoning. Its important to understand that the term synthetic drugs were using here today describes substances that are primarily manufactured in clandestine chinese laboratories and actually represents chemical combinations that are designed to mimic the effects of illegal chemicals with stimulant depressant or hallucinogenic properties. They are not organic, unsafe recreational drugs that produce psycho active or mindaltering effects. Many of these substances are markets as incense, plant fertilizer or air freshener and then sold in gas stations or online. Because of their commercial availability, many users presume they must be safe. However, the public should not be fooled. Even though these products may be hiding in plain sight, they are colorfully packaged poison. Unlike most illicit drugs, they contain chemicals with varying potency. For example, synthetic marijuana can contain compounds more powerful than thc. The only goal is to alter the compound to technically create a new compound allowing them to circumvent legislative and regulatory bans. This modification process poses increasing risk to users who are unaware of the reactions the new formulation may cause. It is not until these substances are ingested or inhealed that some can occur, high blood pressure, severe and uncontrollable agitation, seizures and ultimately death. At that point it may be too late for my colleagues or even me as a medical toxicologist to save them. While there is an increasing array of drugs manufactured, high use of synthetic marijuana whether its the data from sam d. E. A. s National Forensic laboratory or poison control centers, it is clear synthetic marijuana use has increased exponentially since it first appeared in the United States a few years ago. For example, according to nflas, there were 21 reports in 2009. By 2012, that number grew to more than 29,000, an increase of more than 1400 . Through the First Six Months of 2014, there were already close to 20,000 synthetic marijuana drug reports. My home state of pennsylvania has been especially hit hard by the increase of use of synthetic marijuana, trailing only new york, mississippi and texas in the number of reported exposures this year. Currently all 50 states have banned some cannabinoids with the majority doing so through legislation. Since synthetic compounds are easily manipulated, many states have passed laws targeting entire class of substances or used broad language to describe the prohibited drugs. Federal statutes must also be updated to meet this constantly evolving challenge. Synthetic drug control act of 2015 would amend the act so that substance can be treated as an analog if it is chemically similar or produces a similar clinical effect. In addition, the bill would add more than 200 known synthetic drugs to schedule 1 of the csa. This legislation is targeted to the manufacturers and distributors of synthetic drugs, not the end users. Hr3537 would amend the analog so that it would only apply to the sale, manufacture, import and distribution of drugs, not simple possession. The easy access to and thoughtless use of synthetic drugs by those who are unaware of their dangerous toxicities not only places their health and lives at risk but can have a profound impact upon my ability to care for all my patients. When users of synthetic drugs need emergency medical attention, theyre utilizing precious resources such as ambulances, Emergency Department beds, hospital personnel, and limited health care dollars. It is both my opinion and that of the American College of Emergency Physicians that this critical issue must be addressed with the enactment of hr 3537 and supplemented by a National Campaign to educate americans about the dangers of using synthetic drugs. Thank you. The chair thanks the gentleman and now recognizes dr. Anderson. Five minutes for your summary. Good afternoon. I am dr. Alan anderson, Orthopedic Surgeon specializing in Sports Medicine. Im also the president of the American Orthopedic Society for Sports Medicine or aosm. Its a Nonprofit Organization made up of 3,400 Orthopedic Surgeons specializing in the care of athletic injuries at every level of competition. 80 of asom meshes are Team Physicians and 60 of our members take care of highcontact collision sports where serious injury can occur. A Team Physician has unique responsibilities and qualificatio qualifications. He or she must have fundamental knowledge of onfield Emergency Care and treatment of musculoskeletal injuries and medical conditions. Today i will discuss the need for a Team Physician to be able to carry controlled substances when traveling with the team and the problems with current law. The fact that workarounds are not practical and why hr3014 the medical control substances transportation act will enable Team Physicians to provide the best quality medical care to our injured athletes. In emergencies or disasters where there is significant trauma, it is critical that a physician have immediate access to controlled substances. There are times such as during air travel or on a bus when the Team Physician is the only medical person available. There are documented cases of players having seizures after concussions on a flight home. And in such situations controlled substances are needed to stop the seizure and perhaps save the athletes life. Additionally, it is humane care to allow a player to take a pain pill if he or she has a broken bone, dislocated shoulder or torn acl. As you watch your Favorite Team on saturdays, one or more athletes is significantly injured in almost every game. These players are your constituents from every state. The Team Physician who is probably a member of asom is there on the sideline to render aid and take responsibility for the athletes wellbeing. This aid is being severely restricted by current law. The current law prohibits the transportation and storage of controlled substances away from the site of storage that is registered with the d. E. A. This makes it illegal for team doctors to transport a limited quantity of critical medications that are needed for pain control or emergency management. This is highly problematic for athletic Team Physicians who need the ability to maintain a limited supply of controlled substances if a player is injured in an away game. The current law also precludes controlled substances from being transported within the same state or across state lines. The current workarounds are problematic. Current options include predispensing medications to every member of the team prior to travel. That would be 80 members on a football team. This would create a logistical nightmare. Delegating the dispensing controlled substances to the whole medical staff and the state of entry, this is also a problem. The opposing Team Physicians can provide medications, but they have to independently examine the patient, and they have limited time due to demands to treat their own team. This would also create malpractice concerns for that physician of prescribing medications and not following that patient. There are also privacy concerns. A local physician is generally caring for the competing team. This would be unacceptable for the Coaching Staff to enter the training room. Hr3014 would address these concerns. It allows the physician who is traveling with the team the ability to appropriately manage the injury in a similar fashion to when in their home facilities. It does not diminish the need or requirement for controlled substances to be monitored at the current level. Records of controlled substances dispensed or maintained and subject to inspection by the d. E. A. At any time. The Team Physician will be responsible for the security of the controlled substances throughout the entire time the team will be traveling and the duration of transport is limited to 72 hours. Military flight surgeons and rural large animal veterinarians have an exemption to carry these medications. Contact sports can be much more perilous than noncombat military maneuvers. It is also hard for me to believe that horses and potentially cows could get better medical treatment than our athletes. This legislation would also benefit patients and physicians who donate their time and declared disaster areas in their states or other states. Therefore, we urge you to support hr3014, the medical controlled substances transportation act, so that we can provide the highest level of care for our injured athletes. Thank you for giving me this opportunity to testify, and im happy to take questions. The chair thanks the gentleman. That concludes the Opening Statements of our second panel. I have a uc request. Id like to submit the following documents for the record. Statements from the college on problems of drug dependence. The National Association of convenience stores. Dr. Cooper, head Team Physician of the dallas cowboys. The from terminatefraternal ord the American College of Emergency Physicians, center for lawful access and abuse deterrence, the American Academy of physician assistants, and the National Association of chain drugstores. Without objection, so ordered. Ill begin the questioning. I recognize myself five minutes for that purpose. Dr. Halverson and dr. Sledge and waller, you can respond here, too. Do you all agree that patients addicted to opioids should receive treatment based on their individual clinical needs . Dr. Halverson . Yes, sir. Dr. Sledge . Absolutely. Dr. Waller . Yes. How would you each advise hhs to take this principle into account when considering how to responsibly implement secretary burwells recent announcement to expand the use of medicationassisted therapy . Dr. Halverson . Since im not a physician, id like to defer to my colleagues here. Go ahead. All right. Dr. Sledge . And i think that prescribing physicians should be trained in all modalities of medicationassisted therapy as well as other options particularly psychosocial treatment with abstinence as an option. Dr. Waller . So weve looked at this very closely in the area that i treat im in charge of a sevencounty area. With patients in figuring out how to treat that sevencounty area. Weve been able to delineate two separate groups of patients which we have good data for, those that started very early in life and started earlier in their adolescence which have a different brain disease than started later in life. Those groups of patients actually separate us out a little bit as far as how treatment works. I have many patients in my clinic that are physicians, pilots and lawyers who i dont give any medication to because generally its not indicated, and we have wonderful outcomes without any medicationassisted treatment with those groups because of many other factors. My groups which are 92 of my patients which are medicated patients or those without insurance, i find that it is a perilous journey to try to treat them without medicine and the data back thats up with a high mortality rate associated with this group of patients specifically. And so dr. Sledge and i are saying the same thing. It is absolutely