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AMERICA’S HEROIN AND OPIOID ABUSE EPIDEMIC 

HEARING 

BEFORE THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

MARCH 22, 2016 

Serial No. 114–155 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 


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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

JASON CHAFFETZ, Utah, Chairman 

JOHN L. MICA, Florida 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

JIM JORDAN, Ohio 

TIM WALBERG, Michigan 

JUSTIN AMASH, Michigan 

PAUL A. GOSAR, Arizona 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

BLAKE FARENTHOLD, Texas 

CYNTHIA M. LUMMIS, Wyoming 

THOMAS MASSIE, Kentucky 

MARK MEADOWS, North Carolina 

RON DESANTIS, Florida 

MICK MULVANEY, South Carolina 

KEN BUCK, Colorado 

MARK WALKER, North Carolina 

ROD BLUM, Iowa 

JODY B. HICE, Georgia 

STEVE RUSSELL, Oklahoma 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

GLENN GROTHMAN, Wisconsin 

WILL HURD, Texas 

GARY J. PALMER, Alabama 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

MATT CARTWRIGHT, Pennsylvania 

TAMMY DUCKWORTH, Illinois 

ROBIN L. KELLY, Illinois 

BRENDA L. LAWRENCE, Michigan 

TED LIEU, California 

BONNIE WATSON COLEMAN, New Jersey 

STACEY E. PLASKETT, Virgin Islands 

MARK DESAULNIER, California 

BRENDAN F. BOYLE, Pennsylvania 

PETER WELCH, Vermont 

MICHELLE LUJAN GRISHAM, New Mexico 

JENNIFER HEMINGWAY, Staff Director 

ANDREW DOCKHAM, General Counsel 

MICHAEL R. KIKO, Transportation and Public Assets Subcommittee Staff Director 

ARI WISCH, Professional Staff Member 

SHARON CASEY, Deputy Chief Clerk 

DAVID RAPALLO, Minority Staff Director 


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C O N T E N T S 

Page 

Hearing held on March 22, 2016 ............................................................................ 1 

WITNESSES 

The Hon. Michael Botticelli, Director, Office of National Drug Control Policy, 

The White House 

Oral Statement ................................................................................................. 6 

Written Statement ............................................................................................ 10 

Mr. Lou Milione, Deputy Assistant Administrator for Diversion Control, Drug 

Enforcement Administration, U.S. Department of Justice 

Oral Statement ................................................................................................. 22 

Written Statement ............................................................................................ 24 

Ms. Kana Enomoto, Principal Deputy Administrator, Substance Abuse and 

Mental Health Services Administration, U.S. Department of Health and 

Human Services 

Oral Statement ................................................................................................. 35 

Written Statement ............................................................................................ 38 

Leana S. Wen, M.D., MSC., FAAEM, Health Commissioner, Baltimore City 

Health Department 

Oral Statement ................................................................................................. 48 

Written Statement ............................................................................................ 50 

The Hon. Teresa Jacobs, Mayor of Orange County, Florida 

Oral Statement ................................................................................................. 101 

Written Statement ............................................................................................ 104 

APPENDIX 

March 19, 2016, Baltimore Sun ‘‘The Effects of Opioid Overprescription Are 

Evident in the Emergency Room’’, submitted by Mr. Mica .............................. 152 

October 30, 2015,New York Times ‘‘In Heroin Crisis’’, submitted by Mr. Lieu . 154 

October 29, 2010 Time ‘‘Marijuana as a Gateway Drug The Myth That Will 

Not Die’’, submitted by Mr. Lieu ........................................................................ 158 

Response from Mr. Milione, DEA, to Questions for the Record ........................... 160 

Response from Ms. Enomoto SAMHSA to Questions for the Record .................. 170 

Response from Dr. Wen, Baltimore City Health, to Questions for the Record ... 182 


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AMERICA’S HEROIN AND OPIOID ABUSE 

EPIDEMIC 

Tuesday, March 22, 2016 

HOUSE OF REPRESENTATIVES

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

Washington, DC 

The committee met, pursuant to call, at 10:01 a.m., in Room 

2154, Rayburn House Office Building, Hon. John Mica presiding. 

Present: Representatives Mica, Turner, Jordan, Walberg, Amash, 

Gowdy, Massie, Meadows, DeSantis, Buck, Walker, Blum, Hice, 

Carter, Grothman, Hurd, Palmer, Cummings, Maloney, Norton, 

Clay, Lynch, Connolly, Cartwright, Lawrence, Lieu, Watson Coleman, DeSaulnier, Boyle, and Lujan Grisham. 

Mr. MICA. Good morning. I would like to welcome everyone this 

morning to the Committee on Oversight and Government Reform, 

and to a hearing which is entitled ‘‘America’s Heroin and Opioid 

Abuse Epidemic.’’ I would like to welcome our ranking member, 

Mr. Cummings, and all the members and our witnesses this morning to this hearing and call the hearing to order. 

Without objection, the Chair is authorized to declare recesses at 

any time. 

The order of business this morning will be as follows. We will 

begin the hearing with opening statements from myself and the 

ranking member. Other members are welcome to submit opening 

statements, and with Mr. Cummings’ support we will leave the 

record open for 5 days, legislative days, for additional comments or 

statements. 

Without objection, so ordered. 

And when we complete the opening statements, we will turn to 

our panel of witnesses. We have five distinguished witnesses today, 

three at the Federal level, one at the state, and one at the local 

level for our hearing. We will swear those witnesses in, and then 

we will hear their testimony, and then we will proceed with questions. So that will be the order of business that will follow. 

So again, welcome, and I will start with my opening statement. 

Unfortunately, the United States is experiencing an historic epidemic of drug overdose deaths. Today, drug overdoses are the leading cause of accidental death in the United States. In 2014—I don’t 

have the 2015 figures yet, but in 2014 there were—listen to this— 

47,055 deaths caused by drug overdose. That means if this hearing 

lasts for two hours, 10 people will die in the next two hours in the 

United States from drug overdose deaths. 

This is a little chart showing you the increase since 1999. I remember I chaired Criminal Justice Drug Policy Oversight SubVerDate Nov 24 2008 11:04 Jul 31, 2017 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\26064.TXT APRIL

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committee from 1998 to 1999, and we thought we had an epidemic 

back in 1999 with 16,000, and I can show you some of the headlines from my local newspapers where we had many people dying 

over a weekend. Unfortunately, that is what we are seeing again 

in my community and across the United States. 

Unfortunately, more Americans have died from drug-related 

overdoses in one year than all that were killed in the lengthy Korean War. If the current trend continues, the annual death rate 

could climb beyond those killed in Vietnam over that multi-year 

struggle in one year. 

The graph from the Washington Post illustrates the disturbing 

rise in drug overdoses between 1999 and 2014. Now, of the 47,000, 

more than 10,000 Americans died of heroin-related overdoses. Heroin use is increasing at a faster rate. If you want to talk about a 

war on women and a war on our young people, the heroin deaths 

are killing our women at twice the rate of men and 109 percent 

more with our youth. 

Unfortunately, we have seen, according to the Centers for Disease Control and Prevention, that again with heroin deaths among 

our youth between 18 and 25 in the past decade have soared and 

again lead the statistics, the deadly statistics. Across all demographics, the rate of heroin-related overdose deaths has increased 

286 percent. 

While the exact cause of this epidemic is up for debate, many experts believe the use of other drugs is also a driving factor. Addiction to other drugs such as prescription painkillers and marijuana 

potentially open the door to an epidemic now destroying families 

and communities. 

Those addicted to other drugs turn to heroin to get a similar high 

because it is cheaper and more readily available. Mexican drug cartels have established heroin trafficking routes here in the United 

States and coming across our borders. Now we see increased supplies in recent years. 

I had a chance to talk with my police chiefs and law enforcement 

folks in the district, our HIDTA folks, our DEA folks, and we are 

seeing an incredible supply, and we will have some questions about 

where that is specifically coming from. We know a lot of it is coming across the Mexican border. 

The impact, unfortunately, is felt in communities across the nation. Just a few weeks ago I met again with all of the local officials, 

and we have one of my local officials who we will hear from in a 

few minutes, Teresa Jacobs, our county mayor in Orange County, 

who has been forced to deal with the heroin epidemic in Central 

Florida in her county. In Orange County alone, and you will hear 

more about this, we had 475 related heroin bookings in 2013. By 

the end of 2015, last year, we had 840. The majority of those arrested were between the age of 18 and 44. 

The Obama Administration, unfortunately, I believe, has been 

sending mixed signals about the use of substances such as marijuana, which is one of the gateway drugs. Talk to anyone who is 

in counseling, treatment, rehabilitation, and you will find out that 

marijuana is a gateway drug, and many of the heroin users start 

there and work their way up the chain of deadly drugs. 


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According to the National Institute on Drug Abuse—now listen 

to this—more high school seniors are now using marijuana than 

cigarettes. A policy that has been adopted, unfortunately, has consequences. The ‘‘Just Say No’’ drug policy which was championed 

by the late First Lady, Nancy Reagan, has turned into a ‘‘Just Say 

Okay’’ policy, and now we are seeing the consequences. 

While improving treatment is a key, enforcement is and must remain an essential part of combatting the heroin epidemic. When I 

talked to the police chief and I saw the numbers in our locale, I 

said, well, it looks like you have been able to keep the lid on some 

of this, although it is now at epidemic proportions. And they told 

me, Mr. Mica, he said this is only because we now have antidotes 

that can bring these people back. The only reason we aren’t seeing 

double or triple the deaths is because our law enforcement and our 

first responders can bring these people back if they can get to them 

in time. 

Not only illegal immigrants are flowing over the Mexican border 

but also illegal drugs. We know that is the main source of the supply of heroin, cocaine, marijuana, and a host of other deadly narcotics. Stopping deadly drugs from entering the United States is a 

Federal responsibility, and we will hear from some of those officials 

engaged in that war. 

New statistics show Federal drug prosecutions, unfortunately, 

are down 6 percent in the last year, 2015. This comes after a 14 

percent drop since the beginning of the Obama Administration’s socalled Smart On Crime initiative. 

Our frontline law enforcement officers, if we are going to save 

more of these kids and others who are overdosing, they should be 

equipped with the resources to prevent and save them from overdose deaths, not just our emergency medical officers. The EMS people get there usually after the first responders, and it may be too 

late. So this is something else we have learned from our local task 

force and law enforcement officials. 

One of the police chiefs in my district informed me that just 

within the last month or so, we had one student who had to be revived from overdosing three times in one week. That is astounding. 

What is astounding is he is still alive and we were able to catch 

that. 

Speaker Ryan announced addressing this current epidemic as a 

priority, and the Senate has acted on some legislation. I believe 

that this is absolutely critical, that this whole drug situation, including the heroin epidemic, become a priority for this Congress. 

I look forward to hearing from our witnesses today as we examine how to protect our communities from this fast-growing and skyrocketing national epidemic. 

I am now pleased to yield to our ranking member, Mr. 

Cummings. Mr. Cummings was my ranking member. We together 

led the effort from 1998 to 2000. I remember going into Baltimore 

with him and conducting hearings there when people were dying 

on the streets in huge numbers. But, Mr. Cummings, we are unfortunately backsliding, and here we are today. But he did a great job 

of trying to save people in his community, and he is now the ranking member of our full committee. 

Mr. Cummings? 


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Mr. CUMMINGS. Thank you very much, Mr. Chairman. I want to 

thank you for holding a hearing on America’s heroin and opioid epidemic. 

I want to take a moment before I start to extend our prayers to 

the people of Brussels, Belgium. 

Mr. MICA. I would join you, and I would ask everyone for just 

a moment of silence, if we could. 

[Moment of silence observed.] 

Mr. MICA. Thank you, Mr. Cummings. 

Mr. CUMMINGS. Thank you, Mr. Chairman. 

Today’s hearing is about a national public health emergency, and 

we need to treat it like one. People are dying in Baltimore, Orlando, Salt Lake City, Manchester, and cities all across our nation. 

We can no longer ignore this public health emergency. 

The Congress needs to put its money where its mouth is and actually help, help our states fund treatment programs to stop this 

epidemic in its tracks. Drug treatment facilities without adequate 

funding are like firemen trying to put out a raging inferno without 

enough water. Last week, Leader Pelosi sent a letter urging Speaker Ryan to schedule a vote on $600 million in emergency funding 

to help states address this epidemic before this recess week. 

Our colleague from Connecticut, Representative Courtney, has 

already introduced this bill in the House, and Senator Shaheen has 

been pressing this legislation in the Senate. Congress should not 

leave town until we take emergency action to increase funding to 

help states combat this epidemic. 

We must also fully fund President Obama’s budget request for $1.1 billion in 2017. This crisis will not end in a day. It will take 

our sustained commitment, and every one of us owes it to our constituents to make that a priority. They want us to take action, and 

they want us to take action now. 

Let me tell you why Federal funding is so important. In my home 

town of Baltimore, I witnessed with my own eyes, in my own 

neighborhood, the destruction drug addiction inflicts on our communities. The first time I ever heard of a drug overdose death was 

55 years ago from heroin, 55 years ago. I didn’t understand it then. 

It was a young man in our neighborhood who we looked up to who 

turned to heroin, named Bey-Bey, and I can remember being so 

confused as to what this was all about. 

So I have seen vibrant neighborhoods and hard-working families 

and communities destroyed. In Baltimore, where many of the victims were poor and black, this went on for decades. Our nation 

treated this issue like a war rather than a public health emergency. We incarcerated generations rather than giving them the 

treatment they needed. 

Now, things are changing. Between 2006 and 2013, the number 

of first-time heroin users nearly doubled. About 90 percent of these 

first-time users were white. This epidemic has become a runaway 

train barreling through every family and every community in its 

path. It has no respect for barriers. It is now responsible for the 

deaths of 78 Americans every single day, every single day. 

Why is this happening? In part, it is a result of doctors over-prescribing pain medication and drug companies urging them on so 

they can make massive profits. I would like to enter into the record 


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an op-ed by Emily Narciso that appeared in the Baltimore Sun on 

March 19th. 

Mr. MICA. Without objection, so ordered. 

Mr. CUMMINGS. I just want to read just a paragraph from this 

article. It says, ‘‘Prescriptions of opioids have been traditionally 

limited to cancer pain and comfort measures. But in the mid-’90s, 

companies began marketing these pills as a solution to a new 

plethora of ailments. In their efforts to expand the market, producers understated and willfully ignored the powerfully addictive 

properties of their drugs. The promotion of OxyContin by Purdue 

Pharma was the most aggressive marketing of a Schedule II drug 

ever undertaken by a pharmaceutical company. The Sackler family, 

which owns Stanford, Connecticut-based Purdue Pharma, achieved 

a place on Forbes’ 2015 List of America’s Wealthiest Families. The 

Sacklers, the richest newcomers to the list, are worth an estimated 

$14 billion,’’ $14 billion. 

Now, going on, as she explains, the United States has only 5 percent of the world’s population, but we consume 80 percent of the 

world’s painkillers. Five percent, ladies and gentlemen, of the 

world’s population, but 80 percent of the painkillers we consume. 

So, yes, I believe it was unconscionable that our nation ignored 

this issue for decades, but now Republicans and Democrats are 

starting to work together, and I thank God that this day has finally 

come and the stars are starting to align for meaningful change. 

We now have people like Orrin Hatch, Chris Christie, Rob 

Portman, Kelly Ayotte, and Mike Pence realizing the severity of 

this crisis and supporting more funding to help our cities and 

states. They are beginning to realize that this is not an urban 

issue, a rural issue, a black issue, an Hispanic issue, or a white 

issue. This is an American issue that affects your sisters, your 

brothers, your sons, and your daughters. 

There is something else we must do. We can no longer allow drug 

companies to keep ripping off taxpayers for life-saving medications. 

The Chairman mentioned just a moment ago the drug naloxone 

and its life-saving effects. Cities all around the country have recognized the need to equip their first responders, police officers and 

public health officials with naloxone, a drug that can reverse opioid 

overdoses in a matter of minutes. But their efforts have been directly undermined by corporate greed. 

As more first responders began using this drug, the company 

that makes it, Amphastar, began to increase its prices by staggering amounts. In May 2014, a 10-dose pack cost the Baltimore 

City Health Department roughly $190. Guess what? Today, it costs 

more than $400 for the life-saving drug. Despite repeated efforts by 

my home state of Maryland, this company continues to over-charge 

for this drug. The company also continues to obstruct congressional 

oversight by refusing to produce all of the documents I requested 

last May, last May, about their massive price increases. 

Mr. Chairman, today’s hearing is rightly focused on the heroin 

and opioid epidemic, but I hope the committee will turn next to my 

request for documents, as well as my request for a hearing with executives from Amphastar. 

With that, let me welcome our esteemed panel of witnesses 

today, and I thank you for being here. In particular, I would like 


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to welcome Dr. Leana Wen, the Baltimore City Health Commissioner, who has done an outstanding job. She is a true national 

leader in developing and carrying out effective solutions to the 

opioid crisis. We are very fortunate to have her heading our health 

efforts in Baltimore, and we are very pleased to have her here 

today. 

And with that, Mr. Chairman, I yield back. 

Mr. MICA. Thank you, Mr. Cummings. 

Again, we will leave the record open for members who came in 

late for 5 legislative days if you would like to submit them at this 

point in the record. 

Mr. MICA. We now want to again welcome our witnesses. Let me 

first introduce them, and then we will swear you in. 

I am pleased to welcome the Honorable Michael Botticelli, and 

he is the Director of Office of National Drug Control Policy at the 

White House. 

We have Mr. Lou Milione, and he is the Deputy Assistant Administrator for Diversion Control at DEA, the Federal Drug Enforcement Administration at the Department of Justice. 

And then we have Ms. Kana Enomoto, and she is the Principal 

Deputy Administrator of Substance Abuse and Mental Health Services Administration at the U.S. Department of Health and Human 

Services. 

And then we have Ms. Leana Wen, and she is the Health Commissioner for Baltimore City Health Department. 

And then I would like to also welcome my requested witness, the 

Honorable Teresa Jacobs, Mayor of Orange County, Florida. 

Some of you have been before us before, some of you haven’t. We 

ask you that you limit your statements to approximately 5 minutes. 

You will see the little monitor. You can also request from the Chair 

additional statements or information be added to the record. So if 

you have a statement and you want to summarize it, you are welcome to do that. 

Since this is an oversight and investigations panel of Congress, 

I would like you to stand now and be sworn. Can you raise your 

right hand? 

Do you solemnly swear or affirm that the testimony you are 

about to give before this committee and Congress is the whole 

truth and nothing but the truth? 

[Witnesses sworn.] 

Mr. MICA. All of the witnesses have answered in the affirmative, 

and we will let the record reflect that. 

We will first turn to our ONDCP representative, the Director of 

the Office of National Drug Control Policy from the White House, 

Mr. Botticelli. 

Welcome, and you are recognized. 

WITNESS STATEMENTS 

STATEMENT OF MICHAEL BOTTICELLI 

Mr. BOTTICELLI. Chairman Mica, Ranking Member Cummings, 

and members of the committee, thank you for the opportunity to 

appear here today to discuss the issues surrounding opioid drugs, 


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including heroin and illicit fentanyl, in the United States, as well 

as our Federal response. 

During his State of the Union address, President Obama specifically mentioned addressing prescription drug and heroin use as a 

priority and an opportunity to work with Congress in a bipartisan 

manner on this issue that transcends party, income level, gender, 

race, and geography. 

The Office of National Drug Control Policy produces the National 

Drug Control Strategy, which is the Administration’s blueprint for 

reducing drug use and its consequences. Using our role as the coordinator of Federal drug control agencies, in 2011 the Administration released a plan to address the sharp rise in prescription opioid 

drug misuse that coincided with a surge in opioid drug prescribing 

at the beginning of this century. As this crisis has evolved with an 

increase in heroin and fentanyl use and overdose deaths, the Administration continues to put forward new initiatives to help deal 

with emerging issues. 

For example, in October the Administration announced a series 

of commitments it obtained from state, local, and private-sector 

partners, as well as Federal agencies, aimed at addressing this epidemic. 

Opioids are having an unimaginable impact on public health and 

safety in communities across the United States. Fifty-seven people 

died each day from opioids in 2010, and by 2014 that figure was 

up to 78 people. The number of drug overdose deaths involving synthetic opioids other than methadone, a category including fentanyl, 

has more than doubled since 2012. 

These overdose rates are harrowing. However, we are making 

some progress. Past-month non-medical use of opioids by Americans 12 and older was significantly lower in 2014 than during its 

peak in 2009, and the number of people initiating the non-medical 

use of prescription pain relievers in the past year also decreased 

significantly during that time. 

Unfortunately, this progress has been counteracted by an increase in the availability and use of heroin. Heroin purity has been 

rising while prices have remained low. The heroin crisis is compounded by the reemergence of illicit fentanyl, a powerful synthetic 

opioid that is sometimes added to heroin to increase its potency or 

used unsuspectingly on its own. Since fentanyl is far more potent 

than heroin, its use increases risk for overdose death. 

While prescription opioid misuse far surpasses heroin use, and 

the transition from non-medical prescription opioid use to heroin 

occurs at a very low rate, a recent review article concluded that 

this transition appears to be a part of the transition of addiction 

among those with frequent use or dependence rather than a response to the reduction and availability of prescription medications, 

as some have speculated. 

Graduate medical education programs do not provide a comprehensive focus on the identification or treatment of opioid use 

disorders. A startling evaluation of health care claims data found 

that a majority of non-fatal opioid overdose victims were receiving 

an opioid from a prescriber, and 91 percent received an opioid prescription again from a prescriber following their overdose. 


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In response last year, President Obama issued a Presidential 

Memorandum requiring all Federal agencies to provide training on 

the appropriate and effective prescribing of opioid medications to 

staff who prescribed controlled substances as part of their Federal 

duties. 

Just last week, the Centers for Disease Control issued recommendations for primary care clinicians on the prescribing of 

opioids to treat chronic pain. The Administration also obtained 

commitments by more than 40 provider groups that more than 

500,000 health care providers will complete opioid prescriber training in the next two years. And the Administration continues to 

work with Congress to make mandatory prescriber education part 

of their controlled substance licensure. 

The Administration has also focused on several key areas to reduce and prevent opioid overdoses, including educating the public 

about overdose risks and interventions, increasing third-party and 

first responder access to the opioid overdose reversal medication 

naloxone, promoting Good Samaritan laws, and connecting overdose victims and persons with an opioid overdose to treatment. 

Yet, there remains in this country a considerable gap that inhibits many victims of this epidemic from accessing the treatment 

they so desperately need. Therefore, the President’s Fiscal Year 

2017 budget proposes $1 billion in new funding over two years to 

support cooperative agreements with states to expand access to 

medication-assisted treatment and to expand access to substance 

use treatment providers in areas across the country most in need 

of providers. And just a few days ago, HHS Secretary Burwell announced $94 

million in Affordable Care Act funding to health centers to expand 

the delivery of substance use services, with a specific focus on 

medication-assisted treatment for opioid use disorders in underserved populations. 

While we appreciate Congress’ support, the President’s proposal 

underscores the need for additional funding to address this epidemic. 

To address the increase in heroin and illicit fentanyl use and 

availability, the National Drug Control Strategy focuses on identifying, disrupting, and dismantling criminal organizations trafficking opioid drugs, working with the international community to 

reduce the cultivation of poppy, and identifying labs creating synthetic opioids like fentanyl and its analogs. 

In addition, last year ONDCP created the National Heroin Coordination Group, which is a multi-disciplinary team of subjectmatter experts to lead Federal efforts to reduce the supply of heroin and fentanyl in the United States, and we have also committed 

$2.5 million in high-intensity drug trafficking area programs to develop a heroin response strategy, providing law enforcement resources to address the heroin threat across 15 states and the District of Columbia. 

We have also been actively engaged with the government of Mexico on efforts to reduce the flow of heroin and fentanyl into the 

United States. Earlier this month, I met with Mexican Attorney 

General Gomez and other interagency representatives. We agreed 

to further collaboration on efforts to disrupt the production of herVerDate Nov 24 2008 11:04 Jul 31, 2017 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 H:\26064.TXT APRIL

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oin and fentanyl. This bilateral cooperation will be mutually beneficial to both our countries. 

Members of the committee, we remain committed to working 

with our Federal, state, local, tribal, and private-sector partners to 

reduce and prevent the health and safety consequences of non-medical prescription opioid, heroin, and illicit fentanyl use. Thank you 

very much. 

[Prepared statement of Mr. Botticelli follows:] 


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Mr. MICA. Thank you, and we will withhold questions until we 

have heard from everyone. 

Let me recognize Mr. Milione and welcome him, our DEA representative. 

STATEMENT OF LOU MILIONE 

Mr. MILIONE. Thank you, Chairman Mica, Ranking Member 

Cummings, and distinguished members of the committee. 

DEA views the combined prescription opioid and heroin abuse 

epidemic as the number-one drug threat facing the country. I appreciate the opportunity to appear before you today and talk about 

what we at the DEA are doing to address that threat. 

Prescription opioids are walking users up to heroin’s door, across 

that threshold, and into heroin’s deadly embrace. Mexican cartels 

are entrenched in communities throughout our country, exploiting 

the prescription opioid abuse epidemic and flooding the country 

with high-purity, low-cost heroin. Those cartels are forming a toxic 

business relationship with the violent distribution cells that are 

slinging that dope in our communities. 

What is the end result? In one year, almost 30,000 of our fellow 

Americans died from a prescription opioid or heroin overdose. As 

everyone has acknowledged, this is an unimaginable tragedy. 

DEA understands that we need a balanced, holistic approach to 

this epidemic. We stand with our interagency partners, including 

those represented here today, and embrace prevention, treatment, 

and education as critical to our success. However, enforcement 

must be a key component of our overall strategy. We need to investigate and bring to justice not those suffering from opioid use disorder but those that are exploiting human frailty for profit. 

Our answer to dealing with this drug threat: attack supply, reduce demand, and power communities, DEA’s 360 Strategy. There 

are three prongs to the strategy: law enforcement, diversion control, and community outreach. My comments today focus primarily 

on the Office of Diversion Control’s role in that strategy, but we 

would be more than happy to follow up with details about Operation Rolling Thunder. 

Rolling Thunder is the heroin enforcement prong of the 360 

Strategy that is focused on the violent distribution cells that are 

pushing heroin in our communities and the Mexican cartels that 

are supplying the heroin that is killing so many Americans. 

With 1.6 million DEA registrants, DEA diversion is uniquely positioned to assist in this fight with enforcement, education, and engagement. The vast majority of those 1.6 million registrants are 

law-abiding citizens. These are our practitioners, pharmacists, 

manufacturers and distributors working in all our communities. 

We investigate the very small percentage of those that are operating outside the law but yet inflict considerable harm on our country: for example, practitioners not prescribing for a legitimate medical purpose outside the usual course of professional practice; pharmacists not performing their corresponding responsibility to ensure 

that the prescription is valid; manufacturers and distributors not 

upholding the regulatory obligations to prevent diversion. 

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parts. Our tactical diversion squads are specialized units made up 

of agents, diversion investigators, and intel analysts. We have 69 

of them nationally. We are going to add eight, bringing our number 

up to 77 within the next six to nine months. 

We are creating two mobile tactical diversion squads that can deploy where the need is, giving us a fluid enforcement capability. 

We have almost 700 skilled diversion investigators spread across 

this country in our diversion groups. Both the tactical diversion 

squads and the diversion groups work with their respective U.S. 

Attorney’s Office to bring criminal and/or civil charges against 

those registrants that are operating outside the law; and, where 

appropriate, they bring administrative actions, DEA’s Orders to 

Show Cause or immediate suspension orders, potentially revoking 

a registrant’s DEA registration. 

As I said earlier, enforcement will be a key part of the overall 

strategy, but engaging with that large registrant community and 

educating them are just as critical. In the last two years, DEA diversion has conducted more than 300 events, providing education 

and guidance to thousands of DEA registrants and industry leaders. Since 2011, with our great partners at the National Association of Boards of Pharmacy, we have conducted more than 64 pharmacy diversion awareness conferences in 29 states and have had 

the privilege of interacting with almost 10,000 pharmacy employees 

about the risks of diversion. 

Finally, we will continue engaging with our interagency partners 

on important initiatives, including expanding access to treatment, 

mandatory prescriber education, and the safe and responsible disposal of unwanted, unused prescription drugs. Early in February, 

a leading national chain pharmacy announced that they would 

place drug kiosks in 500 drugstores in 39 states and Washington, 

D.C. We see that as a very positive step in the right direction. We 

look forward to the day when those secure kiosks are so commonplace throughout our communities that people can dispose of their 

unwanted and unused or expired prescriptions frequently, safely, 

and conveniently. 

DEA will also continue our national take-back initiative with national events every approximately six months. During our September 2015 take-back, from 5,202 collection sites we collected 

more than 370 tons of unwanted, unused prescription drugs. Our 

next national take-back event is April 30th, about five weeks from 

now. 

For almost 20 years, I have had the privilege of working with the 

brave men and women of the DEA, along with our Federal, state, 

local, and foreign counterparts, investigating some of the most entrenched domestic and foreign criminal organizations threatening 

our country. This current drug threat, the subject of this hearing, 

is unlike anything I have ever seen. 

We at the DEA will do whatever it takes to fight this epidemic. 

We will attack supply, we will work to reduce demand, we will do 

our best to empower communities. 

I thank you for the opportunity to appear before you and look 

forward to answering any questions you have. 

[Prepared statement of Mr. Milione follows:] 


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Mr. MICA. Thank you, and we will get to questions after all of 

our witnesses. 

Let me recognize Ms. Enomoto. She is the Deputy Administrator 

for the Substance Abuse and Mental Health Services Administration at the Department of Health and Human Services. 

Welcome, and you are recognized. 

STATEMENT OF KANA ENOMOTO 

Ms. ENOMOTO. Thank you. Good morning, Acting Chairman 

Mica. Good morning, Ranking Member Cummings and members of 

the committee. My name is Kana Enomoto, and I am SAMHSA’s 

Principal Deputy Administrator, and I am honored to have been 

delegated the duties and authorities of the SAMHSA Administrator 

by Secretary Burwell. 

Many thanks to all of you for your leadership to raise awareness 

and catalyze action on the nation’s opioid crisis. As you have noted, 

this truly is a matter of life or death. 

I know prescription drugs, heroin, and illicit fentanyl have had 

devastating consequences in many of your districts. I know this because SAMHSA partners with leaders in your communities as they 

implement life-saving programs for individuals with or at risk for 

opioid use disorders. 

For example, the State of Maryland and the City of Baltimore 

are addressing high rates of opioid-related emergency room visits 

and utilizing peers to recruit patients into medication-assisted 

treatment. In Florida, SAMHSA’s Prescription Drug Monitoring 

Program Interoperability Grant helped get critical data to the front 

lines of the fight to prevent prescription drug misuse. In Wyoming, 

we have seen fantastic progress as the state has implemented our 

Strategy Prevention Framework using data and science to focus 

their efforts. And at the Odyssey House in Utah, with SAMHSA’s 

help, it is increasing access to family-based, family-centered residential treatment for pregnant and parenting women with substance use disorders. Healthy babies are being born, and progress 

is being made. 

And while treatment admissions are increasing, overdose deaths 

have reached record numbers, and not enough people are getting 

treatment. As a nation, we will not stem the rising tide of this public health crisis if only two out of ten people with an opioid use disorder have access to the treatment they need. It wouldn’t work for 

diabetes, it wouldn’t work for HIV, and it will not work for addiction. We must join together to ensure that every person with an 

opioid use disorder who seeks treatment finds an open door. 

Toward this end, SAMHSA is proud to support the President’s 

National Drug Control Strategy and Secretary Burwell’s Opioid Initiative. In HHS, the Secretary’s initiative focuses on three high-impact areas: changing prescribing behavior, increasing access to 

naloxone, and expanding the use of medication-assisted treatment 

and recovery. 

It is simple: to prevent prescription opioid misuse, we need to reduce the number of pills in people’s medicine cabinets. SAMHSA 

will encourage the use of CDC’s guidelines for prescribing opioids 

in order to chart a safer, more effective course to management of 

chronic pain. 


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We know the vast majority of physicians and other prescribers 

are dedicated, well-trained professionals committed to their patients’ good health. We must give them the tools they need to deliver high-quality, safe and effective care. 

Since 2007, SAMHSA has provided continuing education to over 

72,000 primary care physicians, dentists, and other health care 

professionals. We also reach local communities through Drug-Free 

Community Grants we administer together with ONDCP. These 

coalitions do yeoman’s work to create environments that promote 

health and prevent drug use, including the misuse of prescription 

drugs, heroin, and illicit fentanyl. 

The second aim of the Secretary’s initiative is increasing access 

to naloxone. As you have noted, naloxone can reverse a potentially 

fatal opioid overdose, but it only works if it is there when you need 

it. In SAMHSA’s Overdose Prevention Course for Prescribers and 

Pharmacists, one of the targeted strategies we promote is co-prescribing of naloxone with opioid analgesics, particularly for patients 

with high risk of overdose. We also let states know that they may 

use their SAMHSA block grant funds to purchase and disseminate 

naloxone, as well as for training and education on its use, and soon 

we will be issuing a funding announcement for states to purchase 

naloxone and equip and train first responders. We appreciate Congress’ strong support in this area. 

The third area of the Secretary’s opioid initiative is expanding 

the use of medication-assisted treatment. Research tells us that 

medications, along with behavioral therapies and recovery supports, are important components of an evidence-based treatment 

plan. However, resources are limited, and MAT remains significantly underutilized. 

As Director Botticelli noted, the President’s Fiscal Year 2017 

budget requests $1 billion in new mandatory funding which would 

focus on the continuum of prevention, treatment, and recovery 

services, expanding the use of MAT, expanding the use of telehealth, and building the substance abuse treatment workforce. The 

initiative also includes, importantly, $30 million in new mandatory 

funding to evaluate the effectiveness of medication-assisted treatment programs under different real-world situations. 

On the discretionary side, SAMHSA proposes to maintain and 

grow investments made by Congress in 2015 and 2016. We are providing funding for 23 more states to expand treatment capacity for 

MAT, and we are preserving the behavioral health safety net by 

maintaining increases to the Substance Abuse Prevention and 

Treatment Block Grant. 

We have also worked with ONDCP and DOJ to clarify and enhance the connection between MAT and the criminal justice system. Drug courts are the most successful criminal justice response 

to addiction in our nation’s history. This year we will prioritize 

treatment that is less susceptible to abuse and diversion and expand our technical assistance to ensure that evidence-based practices are fully implemented. 

With all this new care, who is there to provide it? We must ensure that the substance use workforce is sufficient to meet growing 

demand. As such, we are requesting $10 million for a 

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ty and effectiveness of expanding buprenorphine prescribing to 

nurses and physician assistants, and the Administration has requested $20 million for our colleagues at the Health Resources and 

Services Administration to grow the addictions workforce via the 

National Health Service Corps. 

Finally, SAMHSA is proposing a new regulation to increase the 

patient limit for physicians who have a waiver to prescribe 

buprenorphine. 

Members of the committee, thank you for convening this important hearing. I look forward to working with you to ensure that we 

are using our investments strategically, responsibly, and effectively 

to deliver the greatest possible impact for the American people. 

[Prepared statement of Ms. Enomoto follows:] 


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Mr. MICA. Thank you. 

We will now recognize Dr. Wen, who is with the Baltimore 

Health Department, the City Health Department. 

Welcome, and you are recognized. 

STATEMENT OF LEANA S. WEN, M.D., MSC., FAAEM 

Dr. WEN. Thank you very much, Chairman Mica and Ranking 

Member Cummings, and members of the committee. Thank you for 

calling this important hearing. I am here as an emergency physician who has treated hundreds of patients with opioid addiction. I 

am also here as the Health Commissioner in Baltimore, where I 

have declared the epidemic to be a public health emergency. 

Last year, Baltimore launched our three-pronged approach to 

fight this on the front lines. First, we have to save lives. That is 

why we are making the opioid antidote, naloxone, available to 

every single resident. In the ER, I have given naloxone to patients 

who are about to die and have watched them revive within seconds. 

Naloxone should be part of everyone’s medicine cabinet. In 2015, 

we trained 8,000 people in the city on how to use it, including our 

police officers, who within six months have saved 21 citizens. In 

October, I issued a blanket prescription for naloxone to all 620,000 

residents of Baltimore. 

But saving a life without connecting to treatment is just treading 

water. So our second approach is to increase on-demand addiction 

treatment. We believe that treating addiction as a crime is unscientific, inhumane, and ineffective. So our city’s criminal justice and 

public health teams have partnered on drug treatment courts and 

on a pilot project where individuals caught with small amounts of 

drugs will be offered treatment instead of incarceration. 

The science is clear: addiction recovery requires medication-assisted treatment, psychosocial support, and wraparound services. 

Yet nationwide, only 11 percent of patients with addiction get the 

treatment that they need. Imagine if only one in ten cancer patients could get chemotherapy. Yet my patients come to the ER 

seeking addiction treatment, and I tell them that they must wait 

weeks or months. I have had patients overdose and die while they 

are waiting because we failed to get them help at the time that 

they asked. 

In Baltimore, we have started a 24/7 phone hotline that includes 

immediate access to an addiction counselor or social worker, and a 

direct connection to make an appointment. Our phone line was 

started less than six months ago and already receives about 1,000 

calls per week, including from police officers and family members 

asking for resources. 

We have ample evidence to show what works for treating addiction, but we are nowhere near getting everyone treated, and we are 

still very limited, especially when it comes to wraparound services. 

Take housing. Every year we estimate that there are 18,000 

turnaways for less than 100 recovery beds. Addiction treatment reduces crime and saves society money. We should invest in treating 

today rather than spending it on incarcerating tomorrow. 

Our third approach is to reduce addiction through educating the 

public and doctors. We launched a campaign to reduce stigma and 

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board ads and targeted outreach at libraries, churches, and bars. 

Dontdie.org now has the first-of-its-kind naloxone training so that 

anyone who watches a short 10-minute video can print out my prescription to get naloxone. 

We are also targeting education to physicians. As the Administrator said, doctors want to do the right thing. We have to give 

them the tools to do so. So I have sent best practice letters to every 

doctor in Baltimore to set prescribing guidelines and require the coprescribing of naloxone with opioids. 

We are also alerting doctors to emerging trends. Nationwide, one 

in three fatal overdoses from opioids involves benzodiazepines like 

Valium and Xanax, yet physicians routinely prescribe this dangerous combination together. Last month, I co-led a petition to the 

FDA with 40 other city and state health officials to call for a blackbox warning, which is the FDA’s strongest risk communication, on 

opioids and benzodiazepines. 

There is a lot that Baltimore has done to emerge as a model of 

overdose response and addiction recovery, but we need further support from Congress, including expanding funding for on-demand 

treatment and wraparound services like housing and peer recovery 

specialists; directly funding local jurisdictions, those of us on the 

front lines with highest need; removing regulatory barriers like the 

cap on buprenorphine and IND exclusion; regulating the escalating 

price of naloxone; and funding a national stigma reduction campaign. 

The epidemic of opioid addiction is a national public health emergency, and we know that addiction does not discriminate. We are 

all in this together. So I thank you for calling this hearing and look 

forward to answering your questions. 

[Prepared statement of Dr. Wen follows:] 


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Mr. MICA. Thank you. 

You are not allowed, unfortunately, in these committee hearings, 

to express your opinion or your approval or disapproval. I just have 

to let the public know that. Only your representatives can do that. 

Please now to welcome and recognize from my district, the Mayor 

of Orange County, Florida. Some of you have asked where that is. 

Of course, Orlando is the principal city, and we have our mayor 

who started a heroin task force when we were hit with this epidemic. 

She is also accompanied by our—but they are not going to testify. 

George Ralls, raise your hand, who is our Public Health Director. 

David Siegal, who lost a daughter to a drug overdose and has 

turned that tragedy into a concerted public effort. And Karen 

Diebold Sessions is the former City Commissioner from my fair city 

of Winter Park. 

So I welcome the guests accompanying our mayor and recognize 

Mayor Jacobs. Welcome. 

STATEMENT OF TERESA JACOBS 

Ms. JACOBS. Thank you, Mr. Chairman. Chairman Mica, Ranking Member Cummings, members of the committee, thank you for 

calling this hearing, and thank you for this opportunity to discuss 

a serious threat facing our cities and counties across the country. 

As Mayor of Orange County, Florida, allow me to share a few 

statistics. But first, Mr. Chairman, I would like to ask that a statement from one of our constituents who you just introduced, Mr. 

David Siegal, be added to the record. Mr. Siegal is President of Victoria’s Voice Foundation, and he is father of Victoria Siegal, who 

died last summer from a drug overdose at the young age of 18. 

Mr. MICA. Without objection, so ordered. 

Ms. JACOBS. Thank you. 

Many of you know Orange County as the home to Orlando and 

12 other municipalities. We have a population of 1.2 million people. 

Last year we broke a national record for tourism, entertaining 

more than 62 million visitors. 

But many of you probably don’t know that last year we also lost 

84 lives to heroin overdoses, and probably nobody will know that 

that was a 600 percent increase since 2011. 

Four years ago, like so many other counties across the country, 

we were fighting pill mills. We worked hard. We adopted tough 

regulations at a local and state level. We provided resources to 

break opiate addiction, and we were pretty successful. 

Today, the front line has moved but the battle is tougher than 

ever. Too many prescription drug abusers have found an inexpensive and often deadly alternative, heroin. Despite Central Florida’s 

strong economy and our extraordinary quality of life, heroin has 

absolutely exploded. Last year, approximately 2,000 heroin users 

moved through our county jail. Many of these arrests, in fact most 

of them, were not heroin possession, but they were other related 

offenses resulting from the debilitating effect that heroin use has 

on its users. 

Tragically, in 2015 we housed 100 expectant mothers addicted to 

opioids and heroin. 


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Quite frankly, our county jail has become the treatment center 

of last resort for so many people. Yet too many people still don’t 

realize the severe threat that heroin poses not only to the lives of 

the addicts but to the fabric of our community. 

For the good of our citizens and our whole community, we are 

fighting, and we are fighting hard. Last summer I convened the Orange County Heroin Task Force, and I asked our Sheriff Demings 

to co-chair the effort. We have 22 high-ranking officials who served 

on the task force, from our chief judge to our state attorney, to 

medical professionals in all of our hospitals to our superintendent 

of public schools to representatives of our three colleges. I commend the effort of the Orange County Sheriff’s Office and the Orlando Police Department, as well as our Metropolitan Bureau of Investigation, because since we formed this task force through collaboration and dedication, they have arrested more than 370 heroin-related incidents just in six months, 370. 

Last week our task force concluded its efforts, and it made 37 

recommendations. Similar to the comments that you have heard 

from my colleagues here, we recommend bond increases for trafficking, and we recommend media and social media campaigns 

warning about the deadly nature of heroin. 

Heroin is a serial killer in our community, and so few people recognize it for that. 

Coordinated efforts to avoid fatal overdoses by demanding access 

to naloxone. I commend the work of my colleague here, Dr. Wen. 

Congratulations. Naloxone, as you have heard, is a life-saving drug 

that is used in severe overdose situations; and also to look for new 

opportunities to fight addiction by coupling detox at our jail with 

addiction treatment programs using the drug Vivitrol. Vivitrol is a 

long-acting opioid antidote. 

In addition to moving forward with the implementation of these 

recommendations, we are working with our partners at the National Association of Counties, which has teamed up nationally 

with the National League of Cities. We are working with HIDTA, 

and we are working with other organizations to implement the best 

practices. 

We know there is no single solution, but there are some universal effective approaches. Enforcement is absolutely critical to 

combatting heroin use. In keeping with what we learned with pill 

mills, we must be tireless in educating people that addiction is an 

illness. It is an illness that requires serious medical treatment. 

From law enforcement to families, the life-saving drug naloxone 

needs to be more accessible without a prescription and available at 

a reasonable cost. 

And one final point. I want you to know that in Orange County, 

through our collaborative effort, we are committed to doing everything we can with the resources that we have. Here is where we 

need your help. 

Help stop the influx of drugs across the border. We need you to 

continue to expand your efforts to stop these deadly drugs before 

they enter our communities. Local treatment and law enforcement 

will do their part, but the Federal Government must do everything 

possible to keep this plague from our shores and our communities. 


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Help us treat more addicts. With a regional population of 2.5 million, we have only 26 beds for the uninsured, 26 beds, and yet 62 

percent of the overdoses in our community are among the uninsured. 

And help us raise awareness so that more people will choose not 

to try this deadly drug in the first place. 

To end this crisis and to save lives, we all need to be engaged. 

I thank you for your attention to this critical issue, I thank you 

for your leadership, and I thank you for your service to our country. 

[Prepared statement of Ms. Jacobs follows:] 


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Mr. MICA. I thank you, Mayor Jacobs, for participating today, 

and all of our witnesses. 

Now we will turn to questions, and I will lead off. 

The scope of the problem that we are facing, I don’t think people 

are comprehending this. From 16,000, when we chaired the Criminal Justice Policy Subcommittee, 16,000 to 47,000. We are approaching 50,000 in one year. Heroin is only 20 percent of that, 

10,000 deaths. When are the 2015 figures coming out? 

Mr. BOTTICELLI. We hope to have the 2015 figures by the end of 

the year. But part of what —— 

Mr. MICA. By the end of the year. We can’t get them until the 

end of the year? 

Mr. BOTTICELLI. Well, unfortunately, a part of the issue is that 

these data get reported from county —— 

Mr. MICA. And 47,000 from 2014, and I am afraid it is going to 

be off the charts. That does not count, folks, that does not count— 

there are 35,000 automobile deaths in the United States. Half of 

those, people have some kind of substance in their system when 

they are killing themselves. It used to be that teens, the biggest 

killer of teens was automobile accidents. Now it is drugs. Isn’t that 

right? 

Mr. BOTTICELLI. That is correct. 

Mr. MICA. Yes. It is killing our youth. We haven’t even gotten 

into firearms. Firearms are the tool of the drug trade, and they 

have illegal weapons that they are using to commit robberies, mayhem. Again, it is an astounding number. We haven’t killed this 

many in multiple-year wars as we are killing in one year. 

We will lose, guys, a half-a-million people in a decade at the rate 

we are going, or more. Every family has been affected by it, and 

now it is just a slaughter out of control. 

Now, we have lots of responsibility, and I am all for treatment. 

Treatment is at the end of the process. They have already been addicted. We have got to stop this stuff at our borders. 

I sat with our police chief. I sat with our HIDTA people. We put 

in place the HIDTA. I had to do that by legislation a number of 

years ago because they play political games with even the creation 

of high-intensity drug traffic areas, but we did it years ago. And 

here we are back where we—we are far beyond where we ever were 

then. 

This is out of our newspaper from just a few days ago, six pounds 

of heroin at OIA. They are bringing this deadly, these deadly substances, and it is not just heroin. 

Mexico, you talked about Mexico, and I said it is not just illegals 

coming across the border, but they are coming across with drugs. 

Isn’t that right, Mr. Milione? 

Mr. MILIONE. Yes, that is correct. 

Mr. MICA. I sat with the HIDTA folks and saw the pattern. 

These are cartels. They are organized. 

What I just heard—did you all see what’s his name, El Chapo? 

He said he came across the border, it was like a sieve. That was 

the major drug dealer, the most sought-after drug dealer, and he 

transits the border like it is some kind of a holiday visit to the 

United States. So somehow we have to get a handle on this. 


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I just looked up the prosecutions. The prosecutions, when we 

looked at trafficking with illegal weapons, is down, and prosecution—I talked to some of my DEA folks; they won’t tell you this on 

the record. They are not going to say this, but it is very hard to 

make cases on these guys. A lot of cases are dropped on the traffickers. These are dealers in death. 

You are aware, sir, that we have prosecutions. You build the 

case, you give them to the district, and I am going to demand a 

meeting with my U.S. Attorney in the central district and see why 

the prosecutions are down, but they are down. Did you know that? 

Mr. MILIONE. I have seen that they are down. However, I have 

also seen that sentences have gone up, and I have seen that we are 

focused on the —— 

Mr. MICA. But they are telling me it is hard sometimes to make 

a case. These are murderers, and we can’t stop them. They are 

bringing deadly substances in, and the trafficking pattern, too, trying to find out—some is coming through the U.S. mail. I will say 

they told me the mail is starting to crack down. It gets across the 

border, and then they transit it in the United States like they are 

sending some kind of a gift package. Is that correct, sir? 

Mr. MILIONE. There are many ways that it comes across into 

—— 

Mr. MICA. Through packaging services? Who are also intent on 

getting the package there on time, have to get the deadly drugs 

there on time. 

So we have to look at every avenue. These guys are using the 

border. I was in Mexico years ago. I don’t know if you came with 

me on that trip, Mr. Cummings, but we warned them. 

Now, you can do a DEA signature of heroin and cocaine, can’t 

you? 

Mr. MILIONE. Yes. 

Mr. MICA. And you have looked at the stuff coming across. Where 

is it coming from? 

Mr. MILIONE. Mexico. 

Mr. MICA. And 15 years ago it was all Colombia, wasn’t it? 

Mr. MILIONE. It still comes from Colombia —— 

Mr. MICA. But there was very little. I forget, it was black heroin 

or something, coming out of Mexico. But Mexico was like the amateur hour in this game. Now they have become the pros, and they 

are dumping this stuff in our communities. By the time we get to 

treatment, it is way too late, and it is kind of sad. I mean, I am 

all for the naloxone and having that with our first responders, 

where it should be. But I told you the story one police chief told 

me, three times in one week a student, they had to revive him. 

We have to change our prescription drugs in the cabinet to 

naloxone so people are reviving their surviving kids and family. 

Where is the chart? Now, we have done a good job. Put the chart 

up on heroin versus—okay. Look at the opioid drugs at the top, and 

heroin. We have actually brought that down a little bit when it 

went up. So we have been somewhat effective on cracking down on 

prescription drugs. But look at what is happening with heroin; it 

is off the charts. It is being replaced by a cheaper and more available drug. 


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They told me, sir, and you verify this from DEA, they said the 

price is down. 

Mr. MILIONE. That is correct. 

Mr. MICA. Yes, it is down. When is the price down when the supply is all over the place? 

So it is not just Baltimore. It is not Washington, D.C. It is not 

Orange County. It is New Hampshire, Kentucky, every state in the 

United States we are seeing this. Aren’t we, sir? 

Mr. MILIONE. That is correct. 

Mr. MICA. Yes. So again, I get a little hot to trot over this, but 

our job is protecting the citizens of the United States, primarily national defense. We saw what happened with a terrorist attack in 

Brussels. We are being attacked in our streets, in our schools, in 

our families. 

I mean, again, they killed today 40 people. They killed 50,000 

people in the latest statistics we have, which are more than a year 

old. I know tough enforcement works. It worked with Mayor 

Giuliani in New York. They stopped a lot of the crime, the drugs, 

with zero tolerance. Now we have Just Say Maybe, and I just announced the new Federal policy, Just Say Okay instead of Just Say 

No. 

Doesn’t it have to start, ONDCP Director, with families and communities? 

Mr. BOTTICELLI. I would agree that part of our strategy is to 

focus on primary prevention, that we know that by delaying when 

people use, particularly kids use alcohol, marijuana or tobacco, we 

substantially increase the fact that they are going to have a life 

free of drug —— 

Mr. MICA. And were you aware that high school seniors now 

abuse marijuana more than cigarettes? 

Mr. BOTTICELLI. Yes, I have —— 

Mr. MICA. That is great commentary on our success in combatting this with our youth. 

I would like to yield now to Mr. Clay. 

Mr. CLAY. Thank you, Mr. Chair. And thank you and the ranking 

member for your comments on the heroin and opioid epidemic. 

Let me start with Dr. Wen, and I want to commend you for the 

groundbreaking work that you are doing in Baltimore. You are not 

just talking the talk when it comes to speaking out about ending 

the stigma related to addiction, you are walking the walk when it 

comes to expanding access to treatment for your residents. 

In your testimony, you discuss your efforts to provide treatment 

on-demand on a 24/7 basis for Baltimore residents. I would imagine 

that ensuring someone can access treatment as soon as they 

present themselves as willing to do so is a powerful tool for making 

sure that they actually begin treatment, and that your approach 

will save hundreds or thousands of lives as a result. 

Today, one of the barriers to treatment is the Medicaid IMD exclusion which prohibits Medicaid from paying for community-based, 

non-hospital inpatient residential treatment in a facility of 60 or 

more beds. Unfortunately, the IMD exclusion means that if you are 

on Medicaid, you are treated like a second-class citizen, unable to 

access what may be the appropriate care for your substance use 

disorder. 


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For the residents you are responsible for in Baltimore, do you 

agree that they should have access to the medically appropriate 

care they need whether or not they are on Medicaid? 

Dr. WEN. Thank you, Congressman Clay. I absolutely agree, and 

I thank you for acknowledging that addiction is a disease. If a patient came to the hospital with a heart attack, we would never say 

wait three weeks and maybe if there is a bed available we will get 

you in then. The same thing should apply, and the IMD exclusion 

is not based on evidence. We desperately need residential substance use disorder treatments, and removing the waiver on the 

Federal level will allow us to increase the ability to treat all of our 

patients regardless of their insurance status. 

Mr. CLAY. And that would put those patients on equal footing 

with everyone else so that we don’t seem to be discriminating 

based on level of care. 

Dr. WEN. Yes, and it would also increase more providers whom 

we desperately need at the time, when our treatment capacity is 

just 1 in 10 nationwide. 

Mr. CLAY. Yes, and let me thank you for appearing here today. 

Every city and county, Mayor Jacobs, should have a health commissioner raising the alarm as forcefully and as effectively as Dr. 

Wen is, and hopefully Orange County has that, and Congress will 

finally heed the call and do something significant about the opioid 

epidemic because it seems as though we as a country have come 

together and have decided this is a national emergency. We should 

sit up and pay attention. So let me thank you, too, Mayor Jacobs, 

for being here and for what you have done to raise the level of 

awareness in your community. 

Let me go to Ms. Enomoto. You testified about the work that 

SAMHSA does. Can you describe that work in additional detail? 

You testified that of the $1 billion in mandatory funding, SAMHSA 

proposes $920 million over two years to support cooperative agreements with states to expand access to treatment for opioid use disorders. Why is it important that SAMHSA receive these funds? 

Ms. ENOMOTO. As you have so articulately stated, the need far 

exceeds the capacity of our treatment system today, and we believe 

that every person who has an opioid use disorder who seeks treatment, just as Dr. Wen has done, 24-hour access to treatment, that 

should be the standard of care for everyone. With this President’s 

proposal for $920 million to be infused across two years, we think 

that would super-charge the capacity of our states, of our communities with the greatest need so that individuals who are seeking 

treatment would have an open door window when they are ready 

to get that treatment, because, as we know, the window can be 

small for some people, and we need to take advantage of that opportunity when they come knocking. 

Mr. CLAY. Thank you so much for your response. 

Mr. Chairman, I yield back. 

Mr. MICA. I thank the gentleman. 

Let me recognize Mr. Turner from Ohio. 

Mr. TURNER. Mr. Chairman, thank you for holding this hearing. 

Mr. Cummings, thank you for your comments. This is certainly a 

scourge that is affecting everyone. 


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In my community, I was touring a brand-new hospital, Medical 

Hospital, and was taken back to a conference room to meet with 

the leadership of the brand-new hospital and asked them what is 

their most significant challenge, and they told me babies being 

born addicted to opiates. A brand-new hospital. Out of all the Federal regulations, of all the funding issues that they would have, you 

would not have thought that the biggest challenge a brand-new 

hospital was having was babies addicted to opiates. 

Mr. Botticelli, thank you for all of your efforts. I appreciate your 

leadership. I think you are doing a great job and appreciate your 

advice to Congress as to how we might be able to formulate our todo list. 

Mayor, I am a former mayor. Thank you. You live in your to-do 

list, so thank you for your representation of the community. 

Ms. Enomoto, I would like to put up a few slides that come from 

your Fiscal Year 2017 congressional budget justification, the first 

one being a quote that says that approximately 1 million Americans need but do not access treatment for an opioid abuse disorder. 

Again, these slides come from your Fiscal Year 2017 congressional 

budget justification. 

Ms. Enomoto, when we hold these hearings, we don’t do them 

just merely for increased community awareness. We do them for a 

congressional to-do list, but also for an agency to-do list. So that 

is why I am turning to your budget justification. We know 1 million 

Americans need but do not access treatment. 

The next slide. 

For example, more than 80 percent of state prisoners, 72 percent 

of Federal prisoners, and 82 percent of jail inmates meet the criteria for having either a mental health or substance abuse issue. 

Those are staggering numbers, 80 percent of state prisoners, 72 

percent of Federal, 82 percent of jail inmates, a mental or substance use issue. 

The next slide. 

Studies show—again, your budget justification, Ms. Enomoto. 

Studies show that only 8.3 percent of individuals involved with the 

criminal justice system who are in need of substance use disorder 

treatment receive it as part of their justice system supervision. 

Ms. Enomoto, after I left that hospital, I then began the quest 

of trying to find out in my community where are the resources, how 

can we find resources to provide treatment. In our criminal justice 

system, in our community, I was introduced to people who were 

struggling to try to provide treatment to those who are incarcerated, and then I was introduced to a prohibition in your agency’s 

funding that prevents it from being utilized for those people who 

are incarcerated. 

So in your very agency’s documents, it indicates that the problem—we have a self-sorting, right? We have people who present 

themselves in the criminal justice system with this problem. We 

have an understanding that without treatment, they will not be 

able to transition and we will, as our chairman has said, once 

again be providing assistance to them in either an overdose situation or see them again in the criminal justice system. And yet in 

your funding, there is an exclusion that prevents communities from 


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using dollars that they receive from you to actually address that 

for people who are incarcerated. 

To Mr. Clay’s comments, in Medicare and Medicaid, there are 

also similar exclusions that prevent people who are entitled to receive their treatment from receiving that treatment. 

I have a bill, H.R. 4076, that would eliminate those restrictions, 

that would say this is funding that is already there, it is not an 

increase in funding, although I am for increasing the funding, but 

these are funds that are already there that would just allow those 

people to receive it. 

Now, Ms. Enomoto, your agency, by rule, could eliminate that restriction. Why don’t you? 

Ms. ENOMOTO. You know, I think the issue that you have pointed 

out is clearly so important to communities all across the country. 

We know that people in our jails, in our prisons are over-represented with mental illnesses and substance use disorders, and 

getting them adequate care is absolutely important for this nation. 

At the same time, we strongly support approaches such as drug 

courts, diversion, early diversion, as well as reentry programs, and 

we have made significant investments to ensure that evidencebased —— 

Mr. TURNER. Ms. Enomoto, I appreciate all that. But before I 

completely lose my time, could you please tell me why your agency 

won’t waive the requirement and allow your funding to be able to 

be utilized for those who are incarcerated who need it most? 

Ms. ENOMOTO. You know, I want to make sure that I get you an 

accurate answer to that, so I am happy to follow up further either 

for the record or in person. 

Mr. TURNER. Excellent, and I do appreciate your hard work. I 

know you are trying to assist us also, and I would encourage members to please co-sponsor 4076, because it would help the agency 

have the momentum to waive the prohibition themselves. Thank 

you. 

Mr. MICA. Thank you, Mr. Turner. 

I now recognize our ranking member, Mr. Cummings. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman. 

Dr. Wen, again, I want to thank you for being here. At the beginning of today’s hearing we put into the record an op-ed from the 

Baltimore Sun. ‘‘The Effects of Opioid Over-Prescription Are Evident in the Emergency Room’’ it is entitled. The author explains 

that one reason we are now seeing such a huge increase in heroin 

overdoses is because legal prescription painkillers are being overprescribed. She says, and I quote, ‘‘Once a patient is hooked, he or 

she often turns to street drugs, which can be easier and less expensive to acquire.’’ I think you and just about everybody else has said 

that this morning. 

I want to be clear: I am not trying to blame the doctors. They 

have a very difficult job. But, Dr. Wen, do you agree that one reason we are seeing an uptick in heroin overdoses is because of the 

abuse of prescription opioids? Yes or no? 

Dr. WEN. Yes. 

Mr. CUMMINGS. The op-ed has a startling stat. It says, and I 

quote, ‘‘With only 5 percent of the world’s population, we are consuming over 80 percent of the world’s painkillers.’’ The op-ed exVerDate Nov 24 2008 11:04 Jul 31, 2017 Jkt 000000 PO 00000 Frm 00118 Fmt 6633 Sfmt 6633 H:\26064.TXT APRIL

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plains that drug companies are actively promoting this problem. It 

says, and I quote, ‘‘Prescriptions for opioids have been traditionally 

limited to cancer pain and comfort measures, but in the mid-’90s 

drug companies began marketing these pills as the solution to a 

new plethora of ailments. In their efforts to expand the market, 

producers understated and willfully ignored the powerful addictive 

properties of their drugs.’’ 

Now, that sounds like drug companies are almost like drug pushers. The op-ed cites several examples. For instance, it says this, 

and I quote, ‘‘The promotion of OxyContin by Purdue Pharma was 

the most aggressive marketing of a Schedule II drug ever undertaken by a pharmaceutical company.’’ 

Dr. Wen, this is big business. How in the world do we combat 

this massive and aggressive effort by drug companies when they 

are making billions? Go ahead, I am listening. 

Dr. WEN. Congressman Cummings, thank you for asking that 

question. I appreciate your saying that doctors want to do the right 

thing. We want to do the right thing. And actually, when we talk 

to our communities, our youth also recognize—if you ask our youth 

in schools is heroin good or bad, they are going to say that heroin 

is bad. But we have a culture of excess. We have, because of the 

aggressive marketing of drug companies, we have this expectation 

that there should be a pill prescribed for every pain. This is what 

we have to change. 

So we have to make sure that doctors get the resources, the tools 

that they need, including prescription drug monitoring programs, 

including guidelines that can help with safe prescribing. But also 

we need the resources when we are in the ER. We need the resources to connect our patients to treatment, because otherwise we 

also feel frustrated knowing that our patients need care but we 

can’t deliver it to them. 

Mr. CUMMINGS. Now, you talked about some guidance you sent 

out. Does that guidance also include using painkillers that are not 

so addictive or not addictive at all? 

Dr. WEN. Yes. Our guidelines include three things. The first is 

the necessity of co-prescribing naloxone with any opioids, because 

somebody could die from this, so they should get that as well. The 

second is to be careful about the opioid medications knowing that 

they are not first-line medications. They should only be prescribed 

for severe pain. And the third is for the danger of benzodiazepines, 

which are also killing our residents. 

Mr. CUMMINGS. So the op-ed goes on to explain why drug companies are doing this, and that is no surprise. It is about profit. It 

says, ‘‘The Sackler family, which owns Purdue Pharma, achieved a 

place on the Forbes 2015 list of America’s Wealthiest Families. The 

Sacklers, the richest newcomers to the list, are worth an estimated 

$14 billion.’’ That is appalling. I call that blood money, because 

people are dying big-time. 

I want to go back to something, Ms. Enomoto, and maybe some 

of you others can answer this. Yesterday I was talking to a reporter 

and he was saying that, Cummings, aren’t you concerned that with 

even more money being requested for treatment and to deal with 

this problem, because there are so many more people getting into 


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opioids and heroin, that money will be spread so thin that it will 

not have the kind of impact that you are hoping for? 

Mr. Botticelli? 

Mr. BOTTICELLI. To your point, I think we have to have a comprehensive response to this. First and foremost, we need to rein in 

prescribing behavior in the United States. The Centers for Disease 

Control just put out recommendations last week that closely follow 

the guidance that Dr. Wen put out, because that is where we know 

the significant driver is to the problem. 

But we also know that despite all of our efforts, we still have too 

many people overdosing and dying, largely because they can’t access treatment programs when they need treatment programs, and 

this is why the President has put forward a significant proposal to 

expand treatment capacity in the United States. 

I hear this wherever I go. I just did a town hall forum in Toledo, 

Ohio where the sheriff—I asked the sheriff what one single thing 

the Federal Government should be doing to address this opioid epidemic, and he didn’t say we need more police officers. He said we 

need more treatment capacity because we are arresting too many 

people who haven’t been able to access treatment. 

So we took a careful look at how many people need treatment 

and tried to adjust the proposal to really focus on making sure that 

as many people as possible had access to treatment when they 

needed it. 

Mr. CUMMINGS. Just one more question. Dr. Wen, what happened? In other words, this was not a problem before, not as much 

of a problem, but then something happened. Can you tell me what 

happened? I mean, the numbers that the Chairman cited—and I 

realize that people are moving from the opioids to the heroin, but 

what happened with regard to the opioids to get so many people 

on them, and then for them to move to the heroin? Do you know? 

Dr. WEN. My understanding is that there was aggressive marketing by drug companies, so that the pain scale is something that 

is asked of every patient all the time in the course of their hospital 

stay, but the goal should not be getting to pain free. The goal 

should be appropriate treatment, yet this is the expectation that is 

placed on patients and on doctors. So doctors are put in a hard 

place, too, of satisfying those requirements when all of that was 

done for drug companies’ benefit. 

Mr. CUMMINGS. So doctors have a tough time. In other words, the 

patient keeps coming in, and the pain could be at a 2, being the 

mildest. The patient has a 2, and then he or she comes in and 

doesn’t tell the truth and says I am at a 9. Is that the kind of thing 

that happens? 

Dr. WEN. That definitely happens, and then doctors feel that 

they have to get the patient’s pain to zero, which includes over-prescribing of narcotic painkillers in order to do so. 

Mr. CUMMINGS. Wow. 

Mr. Botticelli, it seems like you wanted to say something. 

Mr. BOTTICELLI. Yes. It seems like we set up an expectation 

whereby opioids are the first-line defense around pain therapies, 

and I think what we are trying to do through the guidance and 

through Dr. Wen is, particularly for people with chronic pain, that 

opioids are not the first-line defense to really substantially reduce 


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pain and we have to focus on other—and the evidence seems to be 

pretty strong that people who are in chronic pain don’t have significantly better functioning when they are on opioids, that we need 

to be thinking about things like exercise and diet and cognitive behavioral therapy and non-opioid-based therapies, particularly for 

people with chronic pain. 

Mr. CUMMINGS. My last question. Mr. Turner asked a critical 

question, Ms. Enomoto. I guess he was talking about treatment in 

prison—is that right?—and what stops you from providing treatment in prison. Is that what he was asking you? 

Ms. ENOMOTO. Yes. 

Mr. CUMMINGS. There is a regulation that says you can’t do that? 

Ms. ENOMOTO. Yes, and I guess I want to check into that so I 

make sure I get you a complete and accurate answer. 

Mr. CUMMINGS. Yes, please do, please do, because I am wondering whether it is something that Congress should be dealing 

with. I don’t know whether that should be in your control or our 

control. You follow me? 

Ms. ENOMOTO. Yes. 

Mr. CUMMINGS. But I would appreciate an answer as soon as 

possible. 

Do you know, Mr. Botticelli? 

Mr. BOTTICELLI. I do not. 

Mr. CUMMINGS. Okay. Thank you. 

Mr. MICA. I think Mr. Turner said it is in their control, and he 

has a bill to remedy that. 

Let me recognize Mr. Walker now. You are recognized, sir. 

Mr. WALKER. Thank you, Mr. Chairman. I appreciate this hearing. I appreciate the panel of witnesses being here today. 

Mr. Botticelli, you just talked a few minutes earlier about treatment. I think you mentioned that that is the one thing the Federal 

Government could do. Treatment is good, and we need more of it, 

but that is reactive after the problem already exists. Is that fair to 

say? 

So let’s start from the very basis. I married into the medical community. My wife can write prescriptions as a family nurse practitioner. She works in a Level I trauma center. One of the things 

that I have seen as a minister for two decades is the introduction 

of marijuana. We heard the statistic today already that more high 

school seniors now do weed instead of cigarettes. 

You recently discussed, I believe, the legalization of marijuana 

during a 60 Minutes profile, if I remember correctly. Do you believe 

that this could potentially lead to future drug use among the 

youth? 

Mr. BOTTICELLI. I do, and I think the evidence is pretty clear, 

that when you are talking particularly about early drug use by 

youth, particularly alcohol, tobacco and marijuana, that that significantly increases the probability that people are going to have 

more significant problems later in life. In that episode I talked 

about the fact that I and the Federal Government do not support 

legalization of marijuana because I do believe that when you look 

at the data in terms of the high levels of marijuana use that we 

have among youth in the country, and particularly when we have 

an industry that is, quite honestly, targeting our youth with things 


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like funny cartoon characters and edibles, that we are in for more 

significant problems in the United States. 

Mr. WALKER. Part of our pop culture now, you could say. 

Mr. BOTTICELLI. I hear that we are replicating kind of what has 

happened in the past. 

Mr. WALKER. Do we have to worry that legalizing marijuana 

could lead to more drug use in the future for not just youth but 

for people in general? 

Mr. BOTTICELLI. We have been tracking data for the past 40 

years, and what it has shown is that when youth perceive using 

drugs, and particularly marijuana, as less risky, we often see an 

increase in drug use, and not only have we had very high and historically high levels of marijuana use among youth, we are also 

seeing historically low levels of perception of risk of marijuana use 

among the youth in our country. 

Mr. WALKER. And just a question, and then I will let you go, 

really quick. I don’t want to use all my time here. Does anybody 

disagree with the findings of Mr. Botticelli? Just for the record, 

does everybody agree that this marijuana usage is the beginning of 

what potentially could be a greater problem? So just for the record, 

I am seeing everybody say yes, except for Dr. Wen. 

Dr. Wen, you have a different opinion? 

Dr. WEN. It is one contributor. Another contributor is our prescription drug crisis. Eighty percent of people who start using heroin first start using prescription painkillers. 

Mr. WALKER. True, but most high school students are not going 

to the doctor and getting prescribed major types of pain relievers. 

Sometimes their first introduction is through purchasing marijuana. Is that fair to say? 

Dr. WEN. Yes, and also through misusing other prescription 

drugs. 

Mr. WALKER. A nice transition. I do want to come to that. I want 

to make sure that we are not painting the doctors as the bad guys 

here today. In counseling some of the people who have gone 

through some of this, as good people as they are, they have learned 

to become master manipulators as far as going into the various 

doctors’ offices and the emergency rooms. Mr. Cummings talked 

about the different pain levels, sometimes the threshold. Obviously, 

there are also scoring systems by customer satisfaction indexes 

that hospitals have to worry about. 

Dr. Wen, would you speak to that? Is that something that is fair 

to say? 

Dr. WEN. Most doctors are—by far, the majority of doctors are 

trying to do the right thing. And similarly, most patients are just 

trying to get the care that they want. Unfortunately, patients have 

the expectation that they have to be pain free. But if I fall down 

and bruise my knee, I will have some pain. Getting opioids is not 

the right answer. 

Mr. WALKER. I agree, and I love what you said, a pill for every 

pain. We have to get away from that culture, as you mentioned a 

little earlier. 

We have seen kind of a plateau even though it is a large number 

of prescriptions. We have to continue to do better, and I think people in the community—I think of Richard and Jennifer 


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Kaffenberger in Central North Carolina. They had a son who had 

no drugs in his system except one thing. He had played a football 

game the night before. He had taken one prescription pain pill 

methadone from his grandmother’s medicine cabinet, and it killed 

him. Sad story, but they have taken that message throughout all— 

they are two educators, two teachers in a middle school in Burlington, North Carolina, and they have traveled different parts of 

the state to bring more awareness of what that can do. 

So I am glad to see that that has plateaued, and we need to continue to stay on top of that, but I am overwhelmingly alarmed at 

the spike, and I would like to see those 2015 numbers as soon as 

those are available of where we are going with this heroin epidemic. It is something—it is a problem for all of us, and we have 

to continue to do more. 

With that, I yield back the balance of my time. Thank you, Mr. 

Chairman. 

Mr. MICA. I thank the gentleman. 

Let me recognize now the gentle lady from New York, Mrs. 

Maloney. 

Mrs. MALONEY. I thank the chairman and ranking member and 

all of the panelists for focusing on this real crisis in health care in 

our country, and it is encouraging to hear your testimony and the 

efforts that are taking place in the city, state, and Federal governments across our country. 

But we in Congress need to put money where our mouth is. In 

the short term, I urge my colleagues to approve the $600 million 

in emergency funding which the professionals are asking for to 

combat this epidemic. From what I am hearing from Dr. Wen and 

others is if we hit the treatment level when they are becoming addicted to the painkillers, if you hit it then, then it doesn’t get to 

another level of the opioid. So I think if we could fund it, that 

would be important. 

Now, the Senate recently acted on this crisis. They passed the 

Comprehensive Addiction and Recovery Act of 2016 to help prevent 

and treat the opioid addiction, but it does not provide any funding. 

So what good is a program, Mayor Jacobs, that doesn’t provide any 

funding? Does this program help people suffering in your city or 

your area? 

Ms. JACOBS. Obviously, Congresswoman, funding is a necessary 

component of any program that we offer. If I could add just one 

thing, because we talked a lot about treatment, and we have mentioned that that is on the tail end, that is reactive. 

This country came together, it galvanized around tobacco use, 

and it profoundly changed the way our youth looked at that. If this 

country would come together, if the Congress, if the state and local 

level, if we would come together around a campaign of awareness 

about how very serious heroin use is, opioid addiction, painkillers, 

all of those things, I think we could make a bigger impact at that 

level and stem the tide of this. But it —— 

Mrs. MALONEY. I think that is a very important point, but that 

whole tobacco effort, a lot of it stemmed access. It stemmed access 

to tobacco, and they made it more difficult to have access to tobacco. I know the CDC just came out with some guidelines that basically say don’t prescribe this so easily, you should have a higher 


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threshold for it, as Dr. Wen said. When you fall down, you hurt 

yourself, you bruise yourself, you are not always completely—you 

are going to have pain sometimes. We have to lower the expectation that no one can have any pain. If you have an operation, you 

are going to have pain. It is certainly better to have pain than to 

become addicted to heroin or something worse. 

But maybe some concrete guidelines on access to it, that maybe 

the scientific community should define what pain level should have 

access to opioids and that it should not be something that everyone 

should expect to be pain free the whole time they are in a hospital. 

How would you react to that, Dr. Wen, to having guidelines that 

really stemmed access to very severe pain levels? Because what we 

are doing is, for someone to be comfortable for a week, we are turning them into addicts. I mean, this is a national health crisis. This 

has got to stop, and I would say to my colleagues on the other side 

of the aisle and on my side of the aisle, we shouldn’t leave here 

until we vote that $600 million that is needed for the program. 

What good is a program if you don’t fund it? It makes it sound like 

we are doing something when we are not really doing something. 

What they need is the treatment in the field. 

But I would like to ask Dr. Wen, what do you think about reversing it, not just education but giving doctors help in knowing what 

threshold of pain would be necessary before this dangerous addictive drug is allowed? 

Dr. WEN. Congresswoman Maloney, thank you for the excellent 

point. I agree with you that doctors need further guidance and 

tools in order to make the best decisions possible for their patients, 

and having guidance would also be useful because we don’t want 

to punish doctors who are doing the right thing. Currently, when 

reimbursement is tied to getting the doctor or getting the patient 

to become pain free, that becomes very difficult for the doctor to 

practice appropriately. 

But I also want to caution that there are appropriate uses for 

opioid medications for cancer pain, for surgery, so we don’t want 

to eliminate that altogether. 

Mrs. MALONEY. Absolutely. But direct guidelines—now, who 

would be the one to do that? The CDC? Have you looked at the 

guidelines that they just came forward with? 

Dr. WEN. I have, and the CDC guidelines we agree with and actually hope that they would go further in requiring the co-prescribing of naloxone, and also in helping us to put further warnings, including black-box warnings, on benzodiazepines and opioids, 

which are the FDA’s highest risk recommendation, to alert both patients and doctors. 

Mrs. MALONEY. Well, my time is up. Thank you. 

Mr. MICA. Let me see. We have Mr. Buck of Colorado. You are 

recognized. 

Mr. BUCK. Thank you, Mr. Chairman. 

Mr. Milione, I have a few questions for you. In 1970, Congress 

enacted the Poison Prevention Packaging Act to address aspirin 

overdose cases with children, and as part of that a tamper-resistant 

container was developed for that purpose. We are now dealing with 

a situation where there are a huge number of young people who 

get these opioids from their parents’ medicine cabinet, and I have 


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been made aware of a product that I am holding right there that 

costs less than $1. It would increase the cost of the prescription 

less than $1, and it has a combination on it. It would require the 

parents to open that. If a child that didn’t have the combination 

tried to get into something like this, it would be evident to the parent that this was opened by someone that didn’t have the combination. Has DEA looked into packaging like this? 

Mr. MILIONE. Congressman, obviously as a father of three, we 

support anything that would serve that purpose, and we are aware 

of that company and that device. 

Mr. BUCK. You are probably aware that the company comes from 

the great state of Colorado also. 

Mr. MILIONE. I almost said that. 

Mr. BUCK. Thank you. 

[Laughter.] 

Mr. MILIONE. So we are aware of it, and we were happy to listen 

to them about that technology. We would support that. We would 

support, obviously, the take-back kiosks to get drugs out of the 

medicine cabinet. That is a critical part of our overall strategy. But 

certainly any technology that would prevent those dangerous drugs 

getting in the hands of children or anyone we would support. 

Mr. BUCK. And what needs to be done? Do we need a law for 

that? And I am not a big proponent of administrative regulations, 

believe me; but can you, by regulation, require that dangerous 

drugs be dispensed in packaging like this? 

Mr. MILIONE. We can require that they are disposed of. The regulations cover that, cover the disposal. As far as requiring how it is 

dispensed, I don’t believe we can. I can certainly take that back 

and look at it. We have to navigate somewhat carefully because if 

this technology were made widely available, that would be great, 

but that would have to come from a private entity. It wouldn’t be 

something that we would be able to mandate necessarily. 

Mr. BUCK. So would you need an act of Congress to require—obviously we are not going to name a company or a particular technology, but we would certainly require opioids to be dispensed in 

some kind of safe container. Would that be something that would 

help you in furthering this goal? 

Mr. MILIONE. It would certainly help prevent it from getting in 

the hands of, like you say, children. It is something we would be 

happy to talk to you about or follow up if there was some pending 

legislation. 

Mr. BUCK. I would appreciate that very much. 

I want to make sure I pronounce this correctly—Mr. Botticelli? 

Mr. BOTTICELLI. Yes. 

Mr. BUCK. Great. Wow. The Federal Government dispenses 

drugs through the VA and other agencies. Again, would it require 

an act of Congress, or could the Federal Government, for purposes 

of its dispensing drugs to Federal employees or veterans, use packaging like this without a Federal law from Congress? 

Mr. BOTTICELLI. I don’t know that, and similarly, I think we 

would have to go back and look at what kind of authority we would 

have or if the Federal Government needs additional authority to do 

that. 


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You know, I will say that part of what we have been trying to 

do at the Federal level is ensure that every Federal prescriber at 

least has some level of mandatory education as it relates to those. 

But as far as mandating a package, I don’t know if we either have 

the authority or we need additional authority to be able to do that. 

I could look into it. 

Mr. BUCK. If you could work with my office on that, I would very 

much appreciate that and look forward to working with you to try 

to develop this in this area. 

I thank the chairman and I yield back. 

Mr. MICA. I thank the gentleman. 

We will recognize now Mr. Lynch, the gentleman from Massachusetts. 

Mr. LYNCH. Thank you, Mr. Chairman. 

I do want to associate myself with the words of the chairman and 

the ranking member earlier on on this issue. I think there is much 

we can do on the treatment side, but up front, there is also the opportunity to reduce the number of people who require treatment, 

and I think we really have to double our efforts in that regard. 

Mike Botticelli, good to see you again. 

Mike, for those who don’t know, headed up our efforts in Massachusetts for quite a few years, did great work, and I want to thank 

Mr. Milione for the DEA’s help. My district has been overrun, so 

you have actually been kind enough to assign DEA officers and 

agents up in my area, working with our local police. So we really 

appreciate the help there. 

Obviously, any individual state doesn’t have impact on the border, but you do, so that has been an enormous help for us in trying 

to interdict some of the heroin pipeline that has been coming up 

into the Boston area. 

I had the honor of co-founding the Cushing House in Boston for 

Boys and Girls. It is actually an adolescent treatment facility because our kids are coming in so young with addictions to both 

opioids and heroin. We have basically 24 beds for boys, 20 for girls, 

but the problem is I have a line out the door, and it is happening 

over and over and over again. 

I do want to say, just as a sidelight here, as I talk to our young 

people—and we have put thousands of kids through our home, and 

it is a long-term rehab facility. While I don’t know if marijuana is 

a gateway drug to heroin, every single kid that I am dealing with 

who is on opioids and on heroin started with marijuana. So there 

is a perfect match, 100 percent. Every kid I am dealing with for 

heroin and for opioids, when I ask them what did you start out 

with, they all say marijuana. So maybe there is a susceptibility 

there or something, I am not sure. It is not anecdotal; it is more 

than that. It is empirical, over thousands of kids, but it certainly 

points in that direction. So I think it deserves a cautionary note in 

terms of some of this marijuana legalization. I think we are buying 

ourselves a huge problem. 

One thing I want to talk about and get your opinion, we haven’t 

talked about the power of these opioids, and I will give you a couple of examples. A young woman in my district had a tooth problem. She had an extraction. They gave her a very large prescription 

of OxyContin. She consumed that, went back and complained, 


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falsely she tells me now, of continued tooth pain, got another prescription, and actually went back in and complained that another 

tooth was hurting, which was not. So she is yanking teeth out of 

her head just so she could get prescriptions of OxyContin. That is 

unbelievable. 

I talked to some of my docs in the Boston area, and they tell me 

that the chemical changes in the brain, it overrides—the 

OxyContin and hydrocodone actually overrides the endorphin creation in the brain. So it is more powerful than the endorphins that 

the brain can produce on its own. So when they come off that, 

when they need that, that is why they are going for more 

OxyContin or heroin, because that is the only thing that can 

scratch that itch. 

So we have to think about this. These drug companies are creating customers for life, customers for life. 

Another young father in my district, shoulder pain. Same deal, 

gave him too much OxyContin prescription. Two or three prescriptions later, bam, now he is buying it on the street. A good dad, good 

family, just totally fell into that trap. 

So we have to figure out—I think it is a huge commercial advantage for some of these companies to produce a product that creates 

a customer for life. We have to think about what we are doing in 

that regard. That is a huge commercial advantage. 

I think that Governor Baker in the Massachusetts legislature 

just came out and said if you are going to prescribe this stuff, you 

can only give so many pills, and we are not going to let you refill 

them. It is also part of our drug monitoring piece that we are doing 

along those lines as well. 

But is there anything on the front end, Mike, that we could be 

doing to stop the number of people? Because once they get in there, 

we are having a terrible, terrible, terrible problem. We have a lot 

of recidivism, a lot of relapse, a lot of money we are spending for 

rehab, and we need to do that, I am not discounting that. But on 

the front end, to stop these kids from being trapped, and other 

unsuspecting patients from being trapped into this cycle, is there 

anything else we can do up front to stop that from happening? 

Mr. BOTTICELLI. Sure, and I thank you for that question because 

I think it is really important. Again, the CDC just released guidelines, but they are only guidelines. I agree that I think the vast 

majority of physicians and dentists are well meaning, and part of 

what Massachusetts has done, 16 other states, there is legislation 

in Congress now. We would love to work with you on mandatory 

prescriber education because we feel, again, this is not about bad 

docs, but they have gotten a lot of misinformation, largely from 

drug companies, that these are not addictive medications, and that 

we can continue to hand them out. 

I don’t think, quite honestly, in the middle of an epidemic, it is 

unreasonable to ask a prescriber to take a minimal amount of education as it relates to safe and effective opioid prescribing. If you 

look at the overdoses that we have seen here, there is a direct correlation between the amount of prescriptions that we are giving out 

and overdose deaths, and this has been going on for 10 years, and 

I think the medical community has a role to play, and that is a 

good starting point. 


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Mr. LYNCH. What about liability? What about having joint and 

several liability for drug companies and the docs that push this 

stuff out there? Because these people are unsuspecting and they 

are getting addicted like that. 

Mr. BOTTICELLI. I agree, and there has been legal action against 

Purdue Pharmaceutical for precisely that reason. They have a role 

to play not only in terms of making sure they are meeting the letter of the law about marketing, but also encouraging abuse-deterrent formulations, another particularly important area. 

We do need to work with the DEA and others to go after outlying 

prescribers who are wantonly ignoring the law on this. But you are 

right, we need prescriber education, good prescription drug monitoring programs so physicians can identify people who might be 

going from doctor to doctor to do that. 

But to your point, if we are really going to reduce the magnitude 

of the problem, we have got to scale back on the prescribing and 

identify people who are starting to develop problems. 

Mr. LYNCH. Thank you, and I yield back. 

Mr. MICA. I thank the gentleman. 

Also, Mr. Lynch, I went into one of the drug programs in my 

community, talked to every kid I could in the treatment program. 

Every kid told me the same thing, he started with marijuana, then 

they go on to all the rest of it. So we have a very serious situation 

in this country. 

Let me recognize—Mr. Walberg is next, the gentleman from 

Michigan. 

Mr. WALBERG. Thank you, Mr. Chairman. I apologize for being 

out but Rosie the Riveter showed up at the Capitol and I wanted 

to say hi to four of them from my district. 

An interesting issue because it does affect all of us. My district 

in Southeast, South Central Michigan has tremendous challenges 

there, and I appreciate the efforts that all of you have shown toward this issue. 

Mr. Milione, how long has the DEA been aware of the increased 

prevalence of fentanyl-laced drugs, and how are you responding to 

this problem specifically? 

Mr. MILIONE. Thank you for the question. We have been aware 

of fentanyl going back a number of years, and we have seen its increasing use and have seen it flood the country. 

What are we doing? We are doing basically what we do with all 

our criminal investigations. We look to target the worst of the 

worst, criminal trafficking organizations, identify them, infiltrate 

them, indict them, capture, convict them. We are trying to educate, 

certainly, our state and locals about the risks associated with 

fentanyl. It is a multi-pronged approach, and it is definitely something we are concerned about. 

We certainly are concerned about the unsuspecting users that 

are being exposed to it when it is combined with heroin or when 

it is put into an exact replica of an opioid pill. 

Mr. WALBERG. Are those the special enforcement challenges that 

you have, or are there others beyond that? 

Mr. MILIONE. There is a whole panoply of different challenges, 

and that is certainly one of them. It also poses a risk to my law 

enforcement brothers and sisters that encounter increasingly 


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fentanyl in an enforcement operation. As you know, it can be inhaled, it can be absorbed through your skin, with tragic consequences. So it certainly is a major problem for us, for users, for 

the country, and then also for law enforcement. 

Mr. WALBERG. What has the DEA learned about the source of 

fentanyl when it appears in heroin? 

Mr. MILIONE. Two primary sources. The majority of it is coming 

up from Mexico, with precursors and actual fentanyl shipped from 

China, from Asia, into Mexico for production, and then across the 

Southwest border, all over the country, particularly up in the 

Northeast, but also directly from China. So those are the two primary threats. 

Mr. WALBERG. It is my understanding that Mexico has been a 

primary source. Is that true? 

Mr. MILIONE. That is true. 

Mr. WALBERG. How are you working to decrease this trafficking? 

Any additional efforts that you can talk about in regards to what 

is coming across the border? 

Mr. MILIONE. We have a great relationship with one of our largest, if not our largest, office in Mexico. We have a great relationship with our counterparts. We continue to work with them on 

those trafficking organizations. The Sinaloa Cartel is probably the 

most powerful cartel down there. It has a tremendous distribution 

network spread across the country. They are capitalizing on the 

prescription opioid abuse epidemic. They are flooding the country 

with heroin, but they are also now flooding it with fentanyl. 

So we are just going to continue an aggressive approach from the 

law enforcement side and do what we do with our state and local 

counterparts every day. 

Mr. WALBERG. Okay. Mr. Botticelli, what efforts is the U.S. engaging in to work with governments where heroin is produced to 

cut off the supply? And then secondly, does this involve identifying 

labs in countries like Mexico which may be a trafficking bonanza 

of heroin and fentanyl in the United States, and what are the biggest barriers to stopping that? 

Mr. BOTTICELLI. As we have looked at this issue, particularly 

heroin and fentanyl, having an aggressive approach that reduces 

the supply is particularly important. I actually was just in Mexico 

a few weeks ago meeting with the Attorney General and high-level 

folks in the government, calling for enhanced action particularly as 

it relates to heroin, looking at enhanced eradication efforts, looking 

at how we go after both heroin and fentanyl labs, and how we continue to support mutual collaboration in going after the organizations that deal with it. 

We have also been working with the DEA and our high-intensity 

drug trafficking areas domestically to look at reducing and going 

after those organizations that are trafficking heroin and fentanyl 

domestically. I think it is really important for us to have this holistic approach and to really focus on a robust law enforcement response to reduce the availability of heroin and fentanyl. 

We have to really look at how we work with our Customs and 

Border Protection folks to increase the detection of both heroin and 

fentanyl. And I think, to Mr. Milione’s point, we have to look at our 


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international work with China that often produces these precursor 

chemicals as it relates to particularly fentanyl production. 

We were actually pleased that China just moved to schedule over 

130 new substances, including one of the precursors, acetyl 

fentanyl. So it really is important for us to work with our international partners, particularly China, Mexico, and working with 

our domestic law enforcement folks. 

Mr. WALBERG. Thank you. I yield back. 

Mr. MICA. I thank the gentleman. 

The gentleman from Pennsylvania, Mr. Cartwright. 

Mr. CARTWRIGHT. Thank you, Acting Chair Mica, and thank you 

to all the witnesses for coming today. I have listened to all of your 

testimony, and it is well taken. 

I come from Pennsylvania. In Pennsylvania, hospitalizations for 

overdoses due to pain medication increased 225 percent from 2000 

to 2014. Drug overdose deaths in Pennsylvania increased by 12.9 

percent between 2013 and 2014, compared to a 6.5 percent increase 

nationally in the same time period. It is a huge problem in Pennsylvania. 

Director Botticelli, you mentioned attending a town hall. Earlier 

this year I did a town hall in my district in Coaldale, in Schuylkill 

County, Pennsylvania. It is a rural place. Typically we get between 

30 and 40 people out for routine town halls. At this one, we had 

over 100 people come out, and nobody was smiling. Every family 

is touched by this crisis, by this epidemic. 

The question is, what can be done to combat it? In Pennsylvania, 

there is a company, Iroko Pharmaceuticals, that is right now using 

nanotechnology and is following the FDA directive to use the lowest effective dose of NSAIDs for chronic pain. Iroko is an African 

American-owned company which is growing by the month, providing not only jobs in Pennsylvania but also a logical solution to 

our national opioid epidemic. 

I also believe there are legislative solutions to help address the 

issue, like H.R. 953, the Comprehensive Addiction and Recovery 

Act. This was introduced in the House by Representative Sensenbrenner of Wisconsin. In the Senate, the same bill was introduced 

by Senator Whitehouse of Rhode Island. That bill passed the Senate, and in the House I am a co-sponsor of 953. It is a bill that 

would adjust existing authorizations and programs to provide a series of resources and incentives to help health care providers, law 

enforcement officials, states and local governments expand drug 

treatment prevention and recovery efforts, and throw funding toward those efforts. I wish to urge Republican leadership to move 

H.R. 953 to the House floor for a vote. It is a concrete step we can 

take in the right direction. 

Now, my colleague, Mr. Lynch, talked about New England, and 

the New England area has been referred to as ‘‘the cradle of the 

heroin epidemic’’ by the New York Times, and I see you nodding 

your head, Mr. Milione. You are aware of that, I take it. 

Mr. MILIONE. Yes, sir, I am. 

Mr. CARTWRIGHT. According to the DEA’s 2015 National Heroin 

Threat Assessment Summary, 63.4 percent of New England law enforcement agencies reported heroin as their greatest drug threat. 

And just last week, Governor Charlie Baker signed legislation makVerDate Nov 24 2008 11:04 Jul 31, 2017 Jkt 000000 PO 00000 Frm 00130 Fmt 6633 Sfmt 6633 H:\26064.TXT APRIL

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ing Massachusetts the first state to pass a statewide cap on firsttime opioid prescriptions. 

My question is, with the rising number of opioid deaths, what 

steps has DEA taken to collaborate with the state and local law enforcement agencies to reduce opioid overdoses and deaths? 

Mr. MILIONE. Congressman, thank you for the question. Under 

the leadership of our Special Agent in Charge up there, Mike Ferguson, they have a great relationship with the U.S. Attorney’s Office, and they have brought together all the different elements— 

state, Federal, local, working with the health community—to identify where the hot spots are, and then to do the community outreach piece, but then also to do the enforcement on the groups that 

are trafficking in those substances. 

Mr. CARTWRIGHT. Okay. And, Director Botticelli, how is the Federal Government working to encourage and support innovative 

ideas by the states to combat the opioid epidemic? 

Mr. BOTTICELLI. I think there are a number of ways that we are 

doing that. One, looking at funding opportunities to provide states 

with the opportunities to really create innovative strategies. One of 

the things that our office does is really look at how do we promote 

some of these innovative things that are happening at the state 

level. So whether that is law enforcement that are working to get 

people into treatment, or things like the 24/7 triage programs. 

So part of what the Federal Government’s response is is ensuring 

that states and locals have the resources they need to continue to 

implement programs that address these issues. Secretary Tennis in 

Pennsylvania I think has really demonstrated some really strong 

leadership in terms of the work that is happening here. I talk with 

the Secretary just about every day in terms of looking at what 

more the Federal Government can continue to do. 

But I think the largest function that we have is making sure that 

states and locals get the resources they need to continue to develop 

and show leadership on this issue. 

Mr. CARTWRIGHT. Well, amen to that, and I yield back, Mr. 

Chair. 

Mr. MICA. I recognize Mr. Hice from Georgia. 

Mr. HICE. Thank you, Mr. Chairman. 

The CDC in Georgia has a report that Georgia alone has seen a 

10 percent increase in overdose deaths. I am sure you have seen 

that in the last couple of years. To me, this is especially alarming 

just for the fact that high school students are using painkiller 

medication at alarming rates which makes them 40 times more 

vulnerable to use heroin. 

The DEA said that heroin is currently available in larger quantities, that it is used by a larger number of people, and that it is 

causing an increasing number of overdose deaths. Is that correct? 

Mr. MILIONE. Yes, sir. 

Mr. HICE. I want to focus on where this stuff is coming from. So, 

Mr. Milione, let me start with you. From your testimony regarding 

the DEA’s new 360 Strategy, which you referred to a little while 

ago, it sounds to me like the DEA is going to focus less on the Mexico-based organizations that are trafficking heroin and focus more 

on the street gangs that are distributing heroin. Is that a correct 

assessment? 


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Mr. MILIONE. Congressman, it actually is not. We are more 

nuanced than that. We are never going to go away from our core 

mission of working up the chain to the cartel leaders in Mexico. So 

the 360 focuses on the link point, the link point that bridges the 

violent distribution cells domestically that are affecting the communities, and also the cartels that are flooding the country with the 

heroin. So it absolutely is not one or the other. It is a comprehensive approach. 

Mr. HICE. So is there a greater emphasis, though, on the distribution side of things now? 

Mr. MILIONE. I wouldn’t say there was necessarily a greater emphasis. It is a shift of focus so that we can do everything we can 

to get the violent distribution cells under control and give the communities back their communities. 

Mr. HICE. Is it fair to say from your assessment that our interdiction efforts with the cartels have failed, or at least not been as 

successful as we had hoped? 

Mr. MILIONE. Congressman, I wouldn’t characterize it as a failure. Interdiction is one part of it, but what we are focused on at 

the DEA is going after the actual individuals that are selling the 

powder, that are pushing it, the infrastructure, the corrupting influence, the money. Those are the things we are focused on. Interdiction is one piece of that. 

Mr. HICE. All right. Sounds to me like you were just then saying 

that the emphasis is going to be on the distribution side of things. 

Mr. MILIONE. No, I don’t believe I said that it was just going to 

be on the distribution. It was going to be on —— 

Mr. HICE. I didn’t say ‘‘just,’’ but the emphasis. 

Mr. MILIONE. There is going to be an emphasis on the distribution, and also on the supply side. 

Mr. HICE. Okay. You mentioned a while ago—and I will just 

shake my head with all of this, because we have been into this war 

on drugs forever, and it is getting worse. We are not making any 

headway on this. You mentioned just a while ago that we have a 

great relationship with the Mexican government and that that relationship—the reality is that heroin is coming across the border 

more now than it ever has. What good is a great relationship if we 

are not addressing the problem? At some point, this thing is getting worse and worse and worse, and we are throwing more and 

more money to it all the time. It frankly doesn’t appear to me as 

though anything is happening to stop the problem that would go 

to the point of what you said a while ago, that we are addressing 

this aggressively. 

Mr. MILIONE. Congressman, as somebody who has served for 20 

years and has seen the sacrifices that the brave men and women 

of the DEA do every day, and dangerous situations in the country, 

and also in the foreign arena, we are doing everything we can to 

deal with this very, very difficult and complicated problem. We are 

working to reduce demand, but we also have to go after the organizations that are flooding our country. 

So the war on drugs is not necessarily a phrase that we would 

use. We do criminal investigations in highly dangerous, sophisticated cartels operating —— 


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Mr. HICE. Well, I take my hat off to those agents who are out 

there in the field, and I am not in any way belittling them. But 

for us to come in here and somehow try to give a picture that we 

are aggressively dealing with the problem when in reality it is getting worse and worse is putting forth a false image. 

Mr. MILIONE. I would have to disagree with the false image. 

Mr. HICE. Well, you can disagree all you want. The fact is the 

problem is getting worse. You yourself have admitted that. 

Mr. MILIONE. Congressman, I don’t disagree that it is a difficult 

problem and that there are parts of it that are getting worse, but 

I am not painting a picture that is inaccurate when I say that we 

are aggressively doing everything that we can, at tremendous sacrifice. 

Mr. HICE. So how many criminals have been arrested and prosecuted under DEA’s Rolling Thunder program? 

Mr. MILIONE. I can’t give you the number of arrests. I can tell 

you that there are 448 investigations in 125 cities around the country. 

Mr. HICE. But you don’t know how many arrests? 

Mr. MILIONE. I would have to get back to you with any specific 

statistics. 

Mr. HICE. Please get back to me. 

Mr. Chairman, I see my time has expired. 

Mr. MICA. I thank the gentleman. 

The gentleman from California, Mr. DeSaulnier, you are recognized. 

Mr. DESAULNIER. Thank you, Mr. Chairman. 

First of all, I appreciate the panel. I think all of us have stories 

about constituents who have been affected by this, and the frustration I think of some of my colleagues at our inability as a country 

to deal with the drug problem, no matter what we have tried. 

I would like to ask a couple of questions on the opiate side. I 

have one constituent who came to me and made me aware of her 

personal situation where her son was going to school at the University of Arizona and drove to Los Angeles with some other students 

to actually go to a doctor in Los Angeles and then overdosed. This 

doctor was just recently convicted, multiple convictions in Los Angeles. 

I have another constituent who went out to walk to a Baskin and 

Robbins on a Sunday afternoon, and one of his two kids was killed 

right in front of him when a woman who had been abusing opioids 

and drinking came across. So all of us have those stories, unfortunately. 

One of the things we were able to do in California—and Mr. Lieu 

and I were part of this in the legislature—was update our prescription monitoring system. So my question is really around electronic 

health records. I would talk to doctors and they would say, well, 

electronic health records are right around the corner. Doctor shopping will be a thing of the past. We worked with the Attorney General in California, and that process is in effect now, but we are just 

waiting to see how effective that is. 

So, Mr. Botticelli, maybe you could tell us—and one of the frustrating things, of course, is when you have this patchwork of different states doing different things, it seems to me that it would 


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be fairly efficient for the Federal Government to provide the infrastructure for a nationwide electronic monitoring system so that the 

Department of Justice in all 50 states and the Federal Department 

of Justice would have red flags so that they would see if a doctor, 

like the doctor in Los Angeles, is abusing his or her privileges, or 

if a client is doctor shopping. 

Mr. Botticelli? 

Mr. BOTTICELLI. Prescription drug monitoring programs have 

been part of our main emphasis since the beginning of this epidemic, and I think to your point, we are seeing a tremendous 

amount of success. When we started we had only 20 states that 

had effective prescription drug monitoring programs, and now we 

have 49 states that do that. We actually thought it was more prudent, because we had so many states that already had an existing 

program, to really look at the state level. 

But to your point, I think what we are trying to focus on next 

is interstate data sharing so that states can talk to one another, 

and interoperability with electronic health records, because that is 

the next phase of—we want to be responsive to physicians in terms 

of the burden of workload and look at how do we get timely information to them by supporting that. So we have been working with 

HHS and others. This is an important priority for governors as 

well, so we have been talking to the National Governors Association in terms of what states can do. 

But this has really been one of the more effective tools that we 

have seen, but we also need physicians to use them. So part of this 

is, again, I think we are very interested in states that have passed 

not only mandatory education but, like Massachusetts just did, 

checking the prescription drug monitoring program not only at first 

dispensing but at every dispensing —— 

Mr. DESAULNIER. So it is mandatory. 

Mr. BOTTICELLI. So they are only as good as when people use 

them. 

Mr. DESAULNIER. And, Ms. Enomoto, maybe you could talk to 

this. In Northern California we have a lot of Kaiser clients. So 

there you have a closed system where there is still a problem, so 

there is a financial aspect to this. For them, if they were able to 

use electronic records both for the cost and efficient use of the system, but also to protect the clients from being either over-prescribed or clients taking advantage of the system, how far away are 

we from having a real strong electronic monitoring system that can 

do both? 

Ms. ENOMOTO. You know, I think we are seeing in some states 

already great progress. So in 2012, SAMHSA had the opportunity 

to issue grants for the enhancement of prescription drug monitoring programs that focused on both the interoperability with 

EHR as well as interstate interoperability. In those grants, during 

the period of the grant, we got six out of the nine states that were 

able to achieve that level of interoperability, and then post-grant 

we have two more states who are now online with their MOUs so 

that they should be able to start exchanging information with their 

EHRs very soon. So out of a relatively small investment, 

partnering with CDC, partnering with the Office of the National 


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Coordinator and ONDCP, we were able to get eight out of nine 

states to achieve that level of interoperability. 

Mr. DESAULNIER. And lastly, the statistics always come to mind. 

The U.S. has about 5 percent of the world’s population, but we use 

over 80 percent of the opiates. How much of this is the criminal 

aspect of it, Mr. Botticelli? 

Mr. BOTTICELLI. I would actually say very little. Again, I think 

this has been a concerted effort by the pharmaceutical companies 

to falsely promote those medications. In 2013, we prescribed 

enough prescription pain medication to give every adult American 

a bottle of pain pills, and I think that is why the CDC guidelines 

become so important, looking at not having opioid therapy as a 

first-line defense for chronic pain, really supporting when you do 

start with opioids for some people who do need them, starting with 

the smallest, the lowest dosage and the smallest possible amount, 

because I really do believe that we have made progress in many 

areas, and I don’t believe that we have made enough progress in 

really implementing safe opioid prescribing behavior. 

Mr. DESAULNIER. Thank you. 

Thank you, Mr. Chairman. 

Mr. MICA. Thank you. 

Let me recognize now Mr. Carter from Georgia. 

Mr. CARTER. Thank you, Mr. Chairman. And thank all of you for 

being here. 

I have been kind of in and out. I apologize. I had three committee 

meetings at one time, at the same time. But I want to associate 

myself, first of all, with all the comments that have been made 

about marijuana being a gateway drug and leading to drug abuse. 

I could not feel more adamantly about that, so I just want to make 

sure everyone understands that. 

For those of you who don’t know, I am a pharmacist, not practicing anymore. The only pharmacist in Congress. I have over 35 

years of experience, and a lot of experience with opioids as a dispenser. I am very blessed that I have never taken any drugs, never 

had that. I am human and I have weaknesses, but that is not one 

of them, and I feel very strongly about that. 

I want to start with you, Mr. Milione. This is very uncomfortable, 

but I will tell you that almost a year ago, a little over a year ago, 

in fact, in Tampa, a judge ruled against the actions of the DEA 

when you raided a compounding pharmacy. You destroyed the 

medication and completely shut down the pharmacy without any 

real cause. This was Westchase Pharmacy in Florida. Are you familiar with that situation? 

Mr. MILIONE. I am not. 

Mr. CARTER. You are not? Well, you need to be because, let me 

tell you, this is not a shining example that you want to point toward. This is an example where one of the supervisors that you 

oversee conducted a raid and at the time had no experience in diversion investigation, hadn’t read the DEA handbook, yet raided a 

compounding pharmacy with tactical gear and guns, shut down the 

business, seized hundreds of thousands of dollars of medicine, and 

improperly stored them, therefore rendering them useless, all because the DEA misinterpreted and failed to follow their own laws. 


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This is, as the judge said, preposterous, and this is not going to be 

accepted. 

Now, look, I support the DEA. I don’t like anybody in health care 

who is not practicing by the best of standards. We have bad pharmacies out there, we have bad pharmacists, we have bad doctors. 

Dr. Wen, there are bad doctors out there. You can’t paint with a 

broad brush. There are bad actors in every profession. But this 

kind of action, this kind is totally unacceptable, Mr. Milione, especially when we have someone coming to your pharmacy bearing 

guns. That is unacceptable. So I hope you will look at that. It is 

Westchase Pharmacy. I hope you will research that and understand 

that. 

I want to ask you, Dr. Wen especially, we have talked about 

opioids being used as the entry-level drug for pain control. One of 

the problems that I see here—and, Mr. Botticelli, you and I have 

worked together before. You know I sponsored the legislation in the 

Georgia State Senate to set up the PDMP for Georgia. But one of 

the problems I see is with the FDA taking a lot of the products off 

of the market. 

Now, specifically I want to talk about propoxyphene. You know, 

propoxyphene was on the market for years and years. I can’t imagine how much I dispensed in my career. But I will tell you, when 

they took it off, what did it do? It led people to opioids. That is the 

only choice the doctors had. What do you do now? You have 

ibuprofen and acetaminophen. That is where you want to start. 

Well, let me tell you, as a practicing pharmacist I can tell you, 

you try to get a patient to take something that is available without 

a prescription, you are not going to be able to convince them that 

it is going to work. You have to have a prescription for it. That is 

just the way it is. No, it is not right, but I will try as hard as I 

can, and I can’t convince them of that. 

And just like the propoxyphene, don’t give me that white one, 

only the pink one works, that is the only one that works. That is 

what you are dealing with. 

But one of the problems, I think, has been the FDA taking—and 

I know that propoxyphene had its problems. I am not trying to 

question that. But what I am trying to point out is that we need 

more entry-level drugs, something in-between the opioids and 

ibuprofen and acetaminophen. That would be better. The CDC 

guidelines that have come out, the prescribing guidelines for doctors, I think that is very, very helpful. It needs to be enforced more. 

It needs to have some kind of teeth in it. 

I am running out of time here because I want to get into so many 

things. 

Another problem is mail-order pharmacies sending these gigantic 

containers of opioids to the doorsteps of people, leaving them on the 

doorsteps for them to be—who knows what is going to happen to 

them. You get a 90-day supply. I have people bringing them now 

to the drugstore my wife now owns. They bring into those drugstores all the time giant containers of opioids. That needs to be 

suppressed, Mr. Milione. The DEA needs to do something about 

that. That is ridiculous and something that we need to address as 

well. 


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The last thing I want to talk about is 21st Century Cures and 

the locking provision. Listen, I am a big proponent of 21st Century 

Cures. I think it is some of the best legislation we have passed here 

since I have been in Congress, and I support it, and I voted for it. 

However, that locking provision is very dangerous and I think it 

needs to be looked at. You have a relationship between pharmacies 

and patients, between doctors and patients. When you get into a 

locking provision, it is going to be very, very difficult, because you 

need pharmacists. You need pharmacists to participate in this and 

help us to curb this problem because it is—let me tell you, I have 

seen it ruin families, I have seen it ruin lives, I have seen it ruin 

careers, and it is worse than can even be imagined at this point. 

Mr. Chairman, I know I have gone over, and I apologize. Thank 

you. 

Mr. MICA. Thank you. 

The gentleman from Virginia, Mr. Connolly. 

Mr. CONNOLLY. Thank you, Mr. Chairman. 

I will say, Mr. Mica and I had a series of hearings in the previous Congress on U.S. drug policy that included marijuana, and 

it forced me to reexamine some things I thought I knew or believed 

about our drug policy with respect to marijuana. But what is disturbing to me, if there is a gateway drug to heroin, it is opioid prescription drug addiction far more than marijuana, and that is why 

this hearing is so timely. It is affecting every community we represent here in this body. It is not a rural phenomenon or an urban 

phenomenon or a suburban phenomenon. 

Well, let me ask you, Mr. Botticelli, how did we get to this point? 

I mean, I don’t want any doctor to leave a patient in pain. Serious 

pain is a terrible affliction, and first you do no harm. But how do 

we draw that line between pain management and just an unbelievable avalanche of prescriptions for opioids that has now led to an 

epidemic of addiction in America? With, presumably, the best of intentions originally. 

Mr. BOTTICELLI. I agree, and I think when you look at the roots 

of this epidemic and what are the significant drivers, yes, there are 

other issues going on. It is really about the over-prescribing of 

these very addictive pain medications that we have. 

Mr. CONNOLLY. But why? How did we get there? Doctors aren’t 

stupid people. 

Mr. BOTTICELLI. Well, I think that doctors were given a significant amount of misinformation from pharmaceutical companies, 

and even from the medical professions themselves, that these were 

not addictive medications. So that was really the start of this, that 

despite scant scientific evidence, there was this full court press to 

basically educate physicians, saying that these medications were 

not very addictive, and at the same time we had what I think is 

a very noble and should be a noble goal, that we have to do a better job at pain treatment in the United States, that there are a lot 

of people who have significant pain and who need it. 

So I think you had this confluence in terms of really a full court 

press to treat pain—the VA even talked about pain as the fifth 

vital sign—and little education on the part of these prescribers 

about how addictive these substances were, about how to identify 

people. So physicians in the United States get very little training 


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on appropriate pain prescribing. I think there was a GAO study 

that showed veterinarians actually get more training on pain prescribing, and physicians get little to no training on substance use 

issues. 

So I think it was this kind of mixture of a whole set of factors 

that really drove up addiction and overdose in the United States, 

and now we have that compounded by heroin and fentanyl availability. 

Mr. CONNOLLY. Dr. Wen, what is effective treatment? I mean, 

what is the system for recognizing somebody has a problem and we 

need to get them treatment? What is efficacious treatment in trying to turn this around early before it moves on to, say, heroin or 

something worse? 

Dr. WEN. It is often said that medicine is an art and not completely a science because even something like pain is subjective. 

What is a pain for you is not the same for somebody else. So that 

is why doctors do need discretion about how to treat each individual patient based on their symptoms and who they are, also recognizing that it is not just about medications. We also have to do 

physical therapy and counseling and education that sometimes 

pain is okay. We don’t have to treat everything with a pill. 

So we very much agree with the increase in the use of PDMPs, 

recognizing that some PDMPs are very cumbersome to use. If I am 

seeing 40 patients in eight hours, I can’t be spending an hour of 

that time figuring out how to get into every patient’s PDMP. 

Mr. CONNOLLY. Got it, but we are running out of time. So what 

is efficacious treatment? What do you recommend in the Baltimore 

Health Department? 

Dr. WEN. We recommend, first of all, judicious use of pain medication so that we are not —— 

Mr. CONNOLLY. I get that. I am talking about treatment. We 

have a problem; what is the treatment? What is efficacious? What 

have we learned? Because, look, we are policymakers up here. We 

want to solve a problem. We get that part. But if we have gotten 

to the point where we have an addictive problem but we are trying 

to prevent that person from going on to the heroin part, what 

works? What, in your experience, works by way of intervention? 

Dr. WEN. One thing, recognizing that addiction is a disease, and 

therefore we have to get people into addiction treatment, which is 

medication-assisted treatment, psychosocial counseling, and wraparound services. We know that the World Health Organization 

shows for $1 invested in treatment, that saves $12 for society, and 

that is something we should invest in. 

Mr. CONNOLLY. Thank you very much. 

Thank you, Mr. Chairman, and thank you for the hearings you 

and I held. They were quite informative —— 

Mr. MICA. I believe the only ones in Congress, and we got criticized for them. 

Government Operations, he was my ranking member, and then 

years ago with the ranking member here. 

Mr. CONNOLLY. Thank you again, and thank you to the panel. 

Mr. MICA. The gentleman from Wisconsin, Mr. Grothman. 

Mr. GROTHMAN. I will yield my first minute to Mr. Carter. 

Mr. CARTER. I thank the gentleman for yielding. 


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I would be remiss if I did not mention next week in Atlanta we 

are having the National Prescription Drug Abuse and Heroin Summit. Representative Hal Rogers from Kentucky, who has been a 

champion for this, is a co-chair of that. I hope that you will be 

there. I hope that my colleagues will be there. This is an opportunity to learn more about prescription drug abuse. It is a great, 

great summit, and I encourage everyone to attend. Thank you. 

I thank the gentleman for yielding. 

Mr. GROTHMAN. Anytime. 

Okay, now I have a question. One of the things that bothers me 

is the legal prescription of opiates. I had two minor health things 

in my life in the last two years that I had earlier in my life. Both 

times, the medical professionals were willing to give opiates, like 

a month’s worth of opiates, for something that had no business 

under any circumstances prescribing opiates, and they wouldn’t 

have five years ago. 

I guess I will start with Mr. Botticelli, but anybody else can 

chime in here. What can we do to stop, in these basic things—I 

would say what they were, but I don’t want to embarrass the medical professionals. They were par for the course. I mean, one of the 

things is we are not going to reimburse for Medicaid, we are not 

going to reimburse for Medicare, we are not going to reimburse 

anything else the Federal Government is kicking in for these sorts 

of problems, no matter how much pain you claim you have, because 

people never used to have it. Or we could perhaps say even for 

CMS. We are just not going to reimburse across the board. And if 

we are going to reimburse, it is for three days, none of this month’s 

prescription stuff. 

Is that something that could be done? I don’t think we can give 

the medical professionals a lot of wiggle room here because they 

have shown in the past they abuse that wiggle room. 

Mr. BOTTICELLI. I think there are a number of things that we 

can be doing. I think, one, you are right, there are opportunities 

to work with not only CMS but private insurance as well with that. 

Mr. GROTHMAN. Why don’t we do it? 

Mr. BOTTICELLI. CMS actually sent out a letter to state Medicaid 

directors this summer to really look at putting in place prescribing 

protocols around that. I also think that we really need to continue 

to focus on mandatory prescriber education. I am not a big fan of 

government mandates around that, but I do think, again, that we 

really need to educate the medical profession about safe and effective opioid prescribing. 

Mr. GROTHMAN. All you need—I don’t mean to cut you off. All 

you need is a little common sense. I mean, if we have that many 

people in the medical field that lacking in common sense, we have 

a bigger problem than lack of education. 

Mr. BOTTICELLI. I don’t think it is a matter of common sense. I 

think it was a matter of the medical profession, very well meaning 

to the largest extent, who were given misinformation on the lack 

of addictive properties of these drugs, and it was really a full court 

press to more appropriately treat pain with a prescribing community that gets little to no training on appropriate pain prescribing. 

Mr. GROTHMAN. Well, 90 percent of the people on average in Wisconsin know this is all screwed up. I can’t believe that the medical 


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professionals need training on this, but okay, if you say they need 

training. 

Now I want to come around to the penalty thing, Mr. Milione. 

I got here late, didn’t hear your name. It seems to me that the penalties for people who sell heroin is not as high as it should be, or 

they are not going to prison as long as possible. One of the problems I have is a lot of this is local stuff, it is not a Federal issue. 

But I assume we do arrest people. The Federal Government arrests 

people who possess heroin, at least enough that you can assume 

that they are dealing in that drug. 

Do we arrest people for that? And if we do, what is the recommended sentence? 

Mr. MILIONE. Congressman, at the DEA at the Federal level and 

in our task forces, we are not focused at all on users or simple possession. 

Mr. GROTHMAN. I am not saying possession. If you get somebody 

with enough heroin, which isn’t very much, that you know it can’t 

be for personal consumption, you know they are going to be selling 

for somebody, what do you do with that person? 

Mr. MILIONE. I can’t really give you a quick answer like that. It 

depends on the investigation and obviously in conjunction with the 

Federal prosecutors we work with, the state prosecutors. They look 

at the conduct, and then ultimately a judge decides what that sentence is going to be based upon the guidance that the judge gets. 

That is the clearest answer I can give you. It is not a very clear 

answer. 

Mr. GROTHMAN. It is a very muddy answer, yes. 

Mr. MILIONE. Yes, but it is the world we live in. 

Mr. GROTHMAN. Okay. I will give you one more quick question, 

then I will hang around here to see whether the Chairman eventually can call on me again if I wait long enough. 

What do they do in other countries on this? I toured another 

country 10 years ago and I asked about a drug problem, and they 

told me the criminal penalty for these severe drugs was shockingly 

high. I won’t say what it was because it might have been wrong, 

shockingly high. 

What do they do in other countries to make sure they don’t have 

this big opiate abuse, say in Southeast Asia in some of these countries where they don’t want to have a penalty, so they hand out? 

Mr. BOTTICELLI. It is interesting that you say that. I actually just 

returned from—there is a U.N. group of my colleagues from around 

the world in terms of looking at the global approach to drug policy, 

and I think that there is an emerging consensus with the vast majority of the countries that we need to continue to focus on an enhanced public health response, that while law enforcement plays a 

key role for some of our major traffickers, that we need to look at 

and continue to explore alternatives to incarceration. 

So I think that there is a kind of consensus among countries —— 

Mr. GROTHMAN. I don’t mean to cut you off. I am well past my 

time, and because I am past my time, I would like it if you would 

answer my question, okay? I know that there are a lot of people 

out there who like this public health response, okay? I am under 

the impression that we put people in prison for a reason, okay? 


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Other countries have very large penalties and much less of an opiate problem. Could you tell me what their penalties are? 

Mr. BOTTICELLI. Well, I think they probably have less of an opiate problem because in many parts of the world most people actually don’t have access to medications at all. So it is not a function 

that they have criminal penalties. 

Mr. GROTHMAN. No, you are wrong. But just tell me what they 

are because these are countries that are fairly advanced, and they 

don’t have an opiate problem, and part of it is the penalties are 

pretty dramatic. Do you know what these penalties are, say in 

places in Southeast Asia? 

Mr. BOTTICELLI. I don’t, but I can tell you that Southeast Asia 

considers labor camps part of their treatment regimen. So I 

wouldn’t necessarily equate drug policy around there as it relates 

to their drug problem. 

Mr. MICA. Thank you. I think in Singapore they also execute 

them. 

Mr. Lieu from California, you are recognized. 

Mr. LIEU. Thank you, Mr. Chairman. 

Mr. Botticelli, thank you for your public service. I have a few 

questions for you. Let me begin by saying that the current heroin 

and opiate epidemic has some similarities to the crack epidemic of 

the 1980s. Unfortunately, our response back then was to increase 

prison sentences. I am pleased to see we are taking a different approach this time, and America is finally starting to realize that 

drug addiction is primarily a disease. 

One of the most noticeable differences between the crack epidemic and the opioid epidemic is that the crack epidemic mostly affected poor communities of color, but the face of the opioid epidemic 

is very different. According to a study published in Journal of the 

American Medical Association, nearly 90 percent of the people who 

tried heroin for the first time in the past decade are white. Does 

that statistic sound largely correct to you, sir? 

Mr. BOTTICELLI. It does. 

Mr. LIEU. I have an article here in the New York Times titled, 

‘‘In Heroin Crisis, White Families Seek Gentler War on Drugs.’’ In 

that article you are quoted as saying, ‘‘Because of demographics, 

the people affected are more white, more middle class. These are 

parents who are empowered. They know how to call a legislator. 

They know how to get angry with their insurance company. They 

know how to advocate. They have been so instrumental in changing 

the conversation.’’ You said that, correct? 

Mr. BOTTICELLI. Correct. 

Mr. LIEU. So I believe that it is important that we need to address these issues among the white middle class, but I want to 

make sure also that our resources are directed across the country 

regardless of socioeconomic or race status. My question to you is 

how to ensure that Federal resources are applied fairly and match 

the unique issues facing individual communities. 

Mr. BOTTICELLI. Thank you for your comment. It is a really important issue to me and to you and Congressman Cummings. I 

have been doing this work for the better part of my life, and I am 

glad that in this country we are finally at a point where we have 

acknowledged the disproportionate impact on people of color and 


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poor folk in terms of this issue, and I am glad we are at a different 

place. I am glad that we have now a huge political movement that 

is happening with people around the country to call for a different 

response. 

I completely agree. I think that we have to make sure that the 

policies that were implemented, that the programs that were implemented are targeted at those communities that have the most 

pressing need, and that when we talk about things like criminal 

justice reform, we are talking about criminal justice reform for everybody, regardless of color, as it relates to this, that our human 

response to this epidemic needs to be a human response for everybody and not just for the 90 percent of white people who are affected by this issue. 

I am glad we have learned a lot over the past 40 years in response to failed drug policies in the past. I am glad we are at the 

place where we are finally acknowledging that this is a disease and 

that we can’t make our jails and prisons our de facto treatment 

programs for anybody. 

So I feel a tremendous responsibility in terms of making sure 

that we use this moment in time where there is broad acknowledgement of the fact that this is a disease and that we can’t arrest 

and incarcerate, that we implement those policies and programs for 

everybody. 

Mr. LIEU. Thank you for that answer. 

Mr. Chairman, I would like to enter for the record the New York 

Times article, ‘‘In Heroin Crisis, White Families Seek Gentler War 

on Drugs.’’ 

Mr. MICA. Without objection, so ordered. 

Mr. LIEU. There have been anecdotal stories today that marijuana is a gateway drug. Are you familiar with an article in Time 

magazine that says, ‘‘Marijuana as a Gateway Drug, the Myth That 

Will Not Die’’? Have you read that article? 

Mr. BOTTICELLI. I don’t know if I read that. 

Mr. LIEU. So let me quote from it. It says, ‘‘Scientists long ago 

abandoned the idea that marijuana causes users to try other drugs. 

As far back as 1999, in a report commissioned by Congress to look 

at the possible dangers of medical marijuana, the Institute of Medicine of the National Academy of Sciences wrote there is no conclusive evidence that the drug effects of marijuana are causally linked 

to subsequent abuse of other illicit drugs.’’ 

Now, it is true there is a correlation, and this article and the 

study explains that underage drinking of alcohol also has a correlation, that those that actually use typically precedes marijuana, and 

that marijuana is not the most common and is rarely the first gateway illicit drug use. And then this article goes on to say why there 

might be a correlation, and one simple reason is that people who 

are extremely interested in altering their consciousness are likely 

to want to try more than one way of doing it. So if you are a true 

music fan, you probably won’t stick to listening to just one band. 

That doesn’t make lullabies a gateway to the Grateful Dead. It 

means people who really like music probably like many different 

songs and groups. 

So isn’t it correct that there is no scientific evidence that marijuana is a causal link to illicit drug use? 


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Mr. BOTTICELLI. I think the evidence is pretty clear that early 

use of alcohol, tobacco and marijuana, often used together, significantly increases the probability that someone will develop a more 

significant addictive disorder later in their life, and I think that the 

more younger people use, the more that those chances grow. 

I also think that the music analogy is kind of inaccurate in this 

situation because early substance use actually affects brain development, not just affects people’s taste, and it actually affects people’s brain development and predisposes people for more significant 

vulnerabilities later in their life. 

Mr. LIEU. Thank you. My time is up. I will send you the article 

on that issue also. 

Mr. Chairman, if I could enter into the record the Time magazine 

article that says ‘‘Marijuana as a Gateway Drug, the Myth That 

Will Not Die.’’ 

Mr. MICA. Without objection, so ordered. 

Mr. MICA. The gentle lady from New Mexico, Ms. Lujan Grisham. 

Ms. LUJAN GRISHAM. Thank you, Mr. Chairman. 

I have no doubt that we will continue in Congress, and localities 

and cities and states will continue the debate about gateway drugs. 

Certainly, I participated in many of those discussions about alcohol, which is really the foundation in terms of creating an environment where you put yourself more at risk, particularly adolescents 

and adolescent drinking. I come from a state, unfortunately, that 

has some of the highest drug abuse rates and the highest overdose 

rates in the country. 

Mr. Botticelli, I appreciate very much you raising the issue in 

your testimony and talking about there is now a very direct and 

specific correlation between the number of prescriptions that have 

gone up and the number of prescription drug issues, which we are 

trying to deal with today. And I would hope that Congress undertakes an effort, when we are combating the opioid problem, that we 

look at drug issues in general, drug policy in general, and certainly 

continue to debate and work on criminal justice reform so that we 

are focusing on both prevention and effective treatment, which is 

really the way to get at it. 

I also want to say I appreciate the panel and members’ questions. I am in a state that just passed legislation that would make 

naloxone available to far more than just the medical providers and 

prescribers, that we want it to be in the jails, we want first responders, and first responders to include family members in close 

proximity so that we can prevent overdose deaths. In a state that 

has a Republican House and a Democratic Senate, there was great 

bipartisan effort to recognize if we can prevent an overdose death, 

let’s do that, but now let’s not minimize everything else. 

So finally, potentially a question, and maybe either Director or 

Dr. Wen. This is a very complex set of problems, and that doesn’t 

mean that we should walk away from it, and I could probably get 

into a debate with you right here about good-faith dispensing and 

how that can be a benefit, and how it will also limit access. One 

of the realities about over-prescribing isn’t just that the sellers, the 

manufacturers of these drugs have done such a great job, now it 


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is cheap, so insurance companies are more than happy to make 

sure that that is right there. 

But if you can’t get back to your physician, you are in the hospital or in the ER and you waited 27 hours to be seen, they need 

to make sure that whatever prescription they are giving you is 

going to tide you over. The issue is that you have lots of these patients who have other family members who then have access to the 

excess medication, and I am struck by the number of now large 

pharmacies that are thinking about making sure that they have kiosks and opportunities for you to get rid of those drugs safely and 

get them out of the hands potentially of guests and kids and families and grandkids, which is clearly part of the epidemic here. 

Given all of these complexities, I really want to talk about the 

behavioral health correlation, too, where we aren’t treating—there 

really isn’t mental health parity. In my state, we now have no behavioral health infrastructure, and I should admit to you that I 

think that is partially the fault of this Administration through 

CMS and HHS. So there is zero treatment available. We have some 

of the highest heroin overdose rates. In Mora County, it has been 

the highest. One in 500 is going to die of a heroin overdose. It is 

huge, and it is not new. It is decades old. 

What are we doing to really create policy that recognizes that behavioral health, that dual diagnosis and self-medicating is really 

also part of this larger problem here? 

Mr. BOTTICELLI. I will start, and then I am sure that other folks 

on the panel can do that. So, I think there are a number of things 

from a large policy perspective that have happened. One is the Affordable Care Act, and one of the dramatic things, why 2 in 10 people get —— 

Ms. LUJAN GRISHAM. I am really going to just caution you. The 

Affordable Care Act is the reason this Administration has said that 

it was okay to cancel 100 percent of all the behavioral health providers in my state. So in that example it doesn’t quite work, although I am a fan of general access, make no mistake. But you 

should know that about New Mexico. 

Mr. BOTTICELLI. Well, I will just say that part of the reason that 

people are not able to access care is the fact that they don’t have 

affordable coverage. We know that from data. The Affordable Care 

Act says a couple of things; one, that mental health and substance 

abuse disorder benefits have to be a part of any marketplace plan. 

That is huge, because there has always been a lack of coverage. 

The second thing that it does, to your point, is basically say to 

insurance companies you can’t discriminate in the provision of —— 

Ms. LUJAN GRISHAM. How are we enforcing that? Because I will 

tell you that access is still a giant issue in my state and so many 

others. So we recognize it in policy, but what are we doing—and 

there are only 10 seconds left—to actually make sure it is occurring? And given that now Medicaid is largely a managed care environment, we are going to debate fee-for-service and managed care 

ad nauseam, I am sure, in further health care reform environments. But the reality is, if the insurance companies aren’t really 

making it available, then you really don’t have access in spite of 

coverage; correct? 


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Mr. BOTTICELLI. I agree, and I should say I hear that a lot in my 

travels around the country, and I think that the Federal Government can do more work around enforcing parity, but states can 

play a key role, and the state insurance commissioners can play a 

pivotal role in this. Providers play a key role in making sure that 

complaints get to state insurance commissioners about this. So we 

all have a role to play in terms of enforcing parity and ensuring 

that we are about to finalize Medicaid managed care rules as it relates to parity. 

So I would agree that we each have a role to play in terms of 

parity enforcement. 

Ms. LUJAN GRISHAM. I am well above my time. Thank you, Mr. 

Chairman, for your flexibility and patience. 

Mr. MICA. Thank you for staying and participating. 

The gentleman from South Carolina, Mr. Gowdy. 

Mr. GOWDY. Thank you, Mr. Chairman. 

Agent Milione—am I pronouncing that correctly? 

Mr. MILIONE. Yes, that is correct. 

Mr. GOWDY. Agent, I want to talk to you in a second about drug 

court. But before we get to drug court, would you agree that there 

are some who traffic in narcotics who themselves are not users? 

Mr. MILIONE. I would agree. 

Mr. GOWDY. So drug court is not going to be much help for us 

or for them because they are not addicts, they don’t use. So let’s 

go with those who are using drugs. I think you would also agree 

with me that folks who use drugs commit robberies and burglaries 

and domestic violence and a host of crimes that we consider to 

have an element of violence. Would you agree with that? 

Mr. MILIONE. Certainly, that contributes to an element of violence, yes. 

Mr. GOWDY. All right. So you have drug dealers who don’t use, 

and then you have drug addicts who are not engaged in Title 21 

crimes. 

Mr. MILIONE. That is correct. 

Mr. GOWDY. All right. There are different models for drug courts. 

Some are diversion programs where you just divert out of the 

criminal justice system altogether. Some you plead guilty and your 

sentence is drug court. We had a dickens of a time in South Carolina in getting criminal defense attorneys to plead their clients to 

drug court even though in the eyes of everyone it is better for their 

client, who happened to be an addict. It is tougher than probation, 

so the criminal defense attorneys had no interest in that. 

So how do we devise a plan where you get drug court even if 

your criminal defense attorney doesn’t want you to have it? 

Mr. MILIONE. Congressman, I don’t know that I am actually the 

right person to answer that since at the Federal level we are working at a level where we are going to take in the Federal system, 

and drug courts aren’t an option. That would be more the state and 

local level with some of our state task forces. So I really wouldn’t 

be in the best position to answer that question. 

Mr. GOWDY. Well, before I go to Mr. Botticelli, I want to ask you 

something that might be in your wheelhouse, and that would be diversion. Do you have a background in diversion, Agent Milione? 

Mr. MILIONE. Yes, yes, yes. 


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Mr. GOWDY. All right. Back in the old days, the standard was if 

physicians prescribe drugs outside the course of a medical practice, 

a professional medical practice, they actually could be prosecuted 

themselves. 

Mr. MILIONE. That is correct. 

Mr. GOWDY. There was a dip, it looked like to me, in the number 

of cases that DEA was pursuing from a diversion standpoint. Was 

that just an optical illusion, or at some point the DEA decided to 

interact more with the pharmaceutical companies and less with the 

physicians who were actually prescribing the medicine? 

Mr. MILIONE. I need to know if you are speaking about criminal 

cases. I am not aware of any dip on criminal or civil cases. But 

then there is also the administrative actions, potentially revoking 

the registrant’s registration. I am not aware—if you are talking 

about criminal, I am not aware that there was a dip in any criminal numbers as far as the criminal prosecutions. 

Mr. GOWDY. Would you check that for me? 

Mr. MILIONE. Be happy to. 

Mr. GOWDY. All right, because —— 

Mr. MILIONE. What span were you speaking to? 

Mr. GOWDY. Well, I have been gone since 2010. 

Mr. MILIONE. Okay. 

Mr. GOWDY. I know that we did DEA diversion cases and we 

prosecuted doctors, and then it just seemed to me that the focus 

shifted over to pharmaceutical companies. 

Mr. MILIONE. I can tell you from a policy perspective, and also 

from what we are doing, it has never been a conscious shift. We 

have aggressively gone after, where appropriate, again a small percentage of the overall number of DEA registrants. But I will certainly look at those numbers and get back to you on that. 

Mr. GOWDY. All right. I know it is hard to prosecute doctors, but 

when you are prescribing medicine without even doing an examination, without even so much as checking blood pressure, you are just 

running a pill mill. I think, with all due respect to my friends on 

the other side, prison might be the right place for those doctors. 

Mr. Botticelli, what kind of drug court can you devise where 

criminal defense attorneys do not advise their clients against their 

overall better health to opt for probation instead of drug court? 

Mr. BOTTICELLI. I am not familiar with that. I would be happy 

to work with you. 

Mr. GOWDY. Have you met any criminal defense attorneys? Are 

you familiar with them? 

Mr. BOTTICELLI. No, I am. Actually, there has been huge support 

across the board as it relates to our drug courts. 

Mr. GOWDY. I am sure there is, if it is a diversion court. I am 

quite certain that there is huge support for that. I am not talking 

about diversion where you have no record and you actually don’t 

face any consequences. I am talking about pleading guilty and your 

punishment is drug court as opposed to probation, with probation 

being much easier than drug court. 

Mr. BOTTICELLI. There are many drug courts that operate under 

that model, right? So it is very interesting to me, and again, it has 

gotten wide support among many folks in the criminal justice 

world. So if there are particular folks you would like us to work 


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with in terms of doing some more education around drug courts, 

what they can do with the various models, we work very closely 

with the National Association of Drug Court Professionals to do 

levels of training and outreach and I would be happy to work with 

you. 

Mr. GOWDY. I am out of time. Mr. Chairman, could I ask one 

more question? 

Mr. MICA. Yes. 

Mr. GOWDY. Let’s assume that you plead guilty to armed robbery 

and your sentence is drug court. How many lapses do you think are 

appropriate before the actual sentence imposed is carried out? 

Mr. BOTTICELLI. I would have to go back and see what the guidelines look like. I would assume that that probably gets interpreted 

different ways by different judges —— 

Mr. GOWDY. I was asking you. 

Mr. BOTTICELLI. I actually don’t know that in terms of if there 

is specific guidance around —— 

Mr. GOWDY. I am talking about best practices. I mean, obviously, 

for the first offense, the first relapse, it doesn’t make any sense, 

but the hundredth doesn’t make any sense either. 

Mr. BOTTICELLI. No. I would have to look at the National Association of Drug Court Professionals. It does put out best practice 

guidance, and I don’t know explicitly what that —— 

Mr. GOWDY. Would you do that for me so we can have an idea 

what is fair? 

Mr. BOTTICELLI. Absolutely. But to your point, I think there is 

an acknowledgement that many people with substance use disorders do relapse, and we need to have a good response in terms 

of that. You are right, people need to be held accountable for their 

actions as well, so it is a real balance between recognizing relapse 

and still holding people accountable. But I would be happy to —— 

Mr. GOWDY. I will tell you what I will do, then. In honor of you, 

I will acknowledge that there are relapses. And in partial honor of 

me, the next time you have a chance to talk to criminal defense attorneys, you tell them that it is overall in their clients’ best interest 

to get off drugs, not to get onto probation, which is much easier to 

navigate than drug court. In the short term it might inure to their 

clients’ benefit. In the long run, it does not. 

Mr. BOTTICELLI. Okay, happy to do that. 

Mr. GOWDY. Thank you. 

Mr. MICA. To conclude, we will do a quick round of summary 

questions. 

Mr. Cummings? 

Mr. CUMMINGS. Dr. Wen, one of the things that is so disturbing 

to me is there are certain areas in Baltimore where people are getting methadone treatment, and when you see the number of people 

whose lives have been destroyed, and we see the masses of them— 

and I would say to the gentleman from South Carolina, would invite you, Mr. Gowdy, I would invite you at some point to come with 

me to Baltimore. When you see the masses of people who are using, 

it is painfully painful, I am telling you. I agree that there are those 

who are selling drugs who are not using. I agree with you that 

there are folks who are going out there and committing a lot of 


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crime. As a matter of fact, probably most of the crime in Baltimore 

has something to do with drugs in one way or another. 

But there is also a group of people who are truly addicted, and 

they are dying at 78 a day. That is major stuff. So I would invite 

you. I think when you see it like that—because the Chairman came 

with me to Baltimore and saw what I am talking about. In some 

kind of way, we have to get to that, and I think there are a lot of 

different remedies to try to address these things, but I am definitely not one that wants to be soft on people who are going around 

and selling death, and I have said that many times. But at the 

same time, we have a lot of people who truly are addicted. 

Dr. Wen, where do you—and the gentleman from South Carolina 

made some good points—where do you draw the line and say, okay, 

I have these addicts, but these addicts, some of them are committing crimes. And what do you think of the methadone treatment? 

Because a lot of people question whether you are just keeping people continuing to be addicted to a substance. Do you follow me? 

Dr. WEN. Thank you very much, Congressman Cummings. So the 

first issue is that we know in Baltimore that there are 20,000 people who use heroin, and many more who are addicted to other 

drugs, and most of the drug arrests that are happening—there are 

73,000 arrests that happen in our city every year. The majority of 

the arrests that happen are for individuals for only selling drugs 

to feed their own habit. 

What they need is not incarceration. What they need is drug 

treatment, and that is what we have to provide, and we have to 

make sure they get treatment while they are incarcerated. If they 

are incarcerated, they have to get treatment in jail as well. 

Mr. CUMMINGS. Can you pause there for one second? One thing 

a lot of people don’t know about heroin is you can be addicted to 

heroin for 30 or 40 years. Am I right? 

Dr. WEN. Yes. 

Mr. CUMMINGS. And still function. Is that right? 

Dr. WEN. Yes. There are some individuals who are very high 

functioning who are in all walks of life, all professions, while they 

are addicted to a variety of drugs, including alcohol as well. 

To your point about treatment, I am a doctor and a scientist and 

I have to use the evidence, and evidence shows that medication-assisted treatment, including methadone and buprenorphine, are the 

first line, they are the standard of care when it comes to opioid addiction. We also agree, though, that we need to have increased 

treatment, including with buprenorphine, which can be given in an 

office-based setting. That will also help us to reduce the stigma 

around addiction. 

And, Congressman Cummings, I want to thank you also for your 

leadership in Baltimore City. We hope that there will be additional 

funding directed to our cities of greatest need, areas of greatest 

need. We are the ones on the front lines, we are the ones who are 

innovating, and we are the ones who need the most resources, rather than have the peanut butter spread evenly across all areas. 

Mr. CUMMINGS. You know, naloxone, the idea that we were get- ting a 10-pack for $190 back in 2014, and then they increased it 

to $400—is that right?—have you seen any movement? I know that 

various states and our attorney general has been trying to work 


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out something where we can get that cost back down. Have you 

seen any movement in that area? 

Dr. WEN. We have not. We have not in Baltimore City. Last year 

we were fortunate to receive a generous donation from a pharmaceutical company to assist us for over 8,000 units of naloxone, but 

we can’t depend forever on the generosity, on the donations from 

companies. We have to have this medication, which is a generic 

medication that is on the World Health Organization’s list of essential medications, available to everyone so that we can save lives. 

Mr. CUMMINGS. Again, I want to thank all of you for being here 

today. We do have a lot to do. It is a very serious problem, and we 

are going to have to try to hit it from a lot of angles. As Chairman 

Mica said, years ago he and I—you were the Chairman—the chairman and ranking member of a subcommittee called the Drug Subcommittee did a lot of work, and we are going to have to do even 

more. So, I thank all of you. 

Mr. MICA. Let’s see. Mr. Grothman? 

Mr. GROTHMAN. Sure. I will give you two quick questions. 

First of all, drunk driving is a big problem in our society, and 

when we arrest somebody for drunk driving, some people are alcoholics and have an addiction to alcohol, and a lot of people are just 

irresponsible people, social pressure, whatever, got a drunk driving 

ticket. I have only met two people in my life who have used heroin. 

They both were in the criminal justice system. Both felt they were 

not addicted. 

Percentage-wise, give me a stab at it. Of the people who are arrested with heroin possession or whatever, what percentage are addicts, and what percentage are just people who are social pressure 

or whatever, want to feel good for the day, are using heroin? What 

percentage do you think need treatment, and what percentage are 

people who are just like the person who gets a drunk driving ticket 

because they are just irresponsible? Could a couple of you give me 

your guess? 

Mr. BOTTICELLI. I will take a stab at it and take a look at it. I 

would assume that the rates of non-addictive heroin use are incredibly low just because it is a very powerfully addictive drug. 

Mr. GROTHMAN. Each one of you just give me a percentage. I 

don’t have a lot of time. What percentage of people who are arrested for heroin are like the two people that I talked to who didn’t 

crave it, didn’t need it, one did it for social reasons and one was 

going through a depression at that time? What percentage are addicted and what percentage are just using it because my buddy is 

using it and it is cool? 

Mr. BOTTICELLI. I would say probably 5 percent of people who 

are using marijuana have no addiction to it, but that would be —— 

Mr. GROTHMAN. You mean heroin? 

Mr. BOTTICELLI. Heroin. I am sorry. 

Mr. GROTHMAN. Only 5 percent are addicted. 

The next gentleman? 

Mr. MILIONE. I can’t give you a percentage. That is not how we 

encounter—we don’t encounter individuals that way based on the 

work that we do at the DEA. So I can’t give you a percentage. 

Mr. GROTHMAN. Okay. Ms. Enomoto? 


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Ms. ENOMOTO. What we can give you is data from our National 

Survey on Drug Use and Health, which just surveys people about 

how many people have used heroin the last month or in the last 

year, and then how many of those people actually meet criteria for 

disorder, and I would imagine you would find fairly parallel realities. We don’t do screening on arrest. We don’t have the time to do 

diagnostic evaluations on everyone who is arrested for possession, 

so we don’t have those data available. 

Mr. GROTHMAN. Do you have an opinion? 

Ms. ENOMOTO. No, but I am happy to get you those data, the 

data that we do have. 

Mr. GROTHMAN. Anybody up there have an opinion? Anyone else 

have an opinion on the percentage that are addicted and the percentage that are just using? 

Dr. WEN. I can give you my perspective as a practicing physician, 

and also experience in Baltimore, which is that the vast majority— 

we are talking well over 90 percent—will be individuals who have 

an addiction. Heroin comes from opium, and it is one of the most 

addictive substances in the world. 

Mr. GROTHMAN. Okay. 

Ms. JACOBS. I don’t have the answer. I can tell you that out of 

the 2,000 people that come through our jail that acknowledge they 

are using heroin, all of them have an addiction. Now, the reality 

is that they are acknowledging it because they know they are going 

to go through withdrawal. 

But, you know, I think that there is some information that we 

could obtain through some databases dealing with people that have 

been prescribed opioids and how many of them have become addicted. I don’t really think —— 

Mr. GROTHMAN. I am out of time. I will cut you off because I 

want to ask one more question. 

Okay, so maybe the two people I have met who have actually 

used heroin and got caught, when they say they were not craving 

it at all, maybe they are an aberration. 

Okay, the next question I have, just one example. If I break my 

arm, just a simple break, do you think under any circumstances, 

given that they never prescribed it 15 years ago, under any circumstances—what percentage of the time do you think a doctor 

should prescribe opiates for a broken arm? 

Dr. WEN. A broken arm is extremely painful, and if somebody 

had come to the ER with a broken arm, I would give them even 

IV medications, including for opioids. So it does make sense that 

this is a reasonable use for opioids. 

Mr. GROTHMAN. Does anybody else think in all cases for a broken 

arm you should be prescribing opiates? For how long? Say for over 

a week? What percent think if you have a broken arm you should 

prescribe opiates, give a prescription for at least a week? 

Mr. BOTTICELLI. I can tell you what the CDC guidelines recommend in those kinds of situations. Obviously, that is a decision 

that needs to be made between the patient and the doctor. There 

should be a conversation to do it. But the CDC guidelines say the 

lowest possible dose and the shortest possible duration. 

Mr. GROTHMAN. So would you, if you were the doctor, give a prescription for at least a week? 


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You know, politicians are known for not giving straight answers, 

not you guys. But okay, go ahead. 

Anybody else have a stab at this? Is it responsible to give a prescription for opiates for at least a week if I crack my arm here? 

Ms. JACOBS. Sir, if I could take a stab at this? 

Mr. GROTHMAN. Sure. 

Ms. JACOBS. I am not a doctor. I am a mother of four children. 

One of my children has had multiple broken bones in sports. One 

of them had three torn ACLs and meniscus tears, so they have all 

gone through a lot of surgery. Each time they have been given 

opioids, and each time I would say it was probably for about a 

week. In all cases they were warned—I was warned about what to 

look for in case of addiction. In every case, they were not on opioids 

for more than 48 hours. We took them off in 48 hours. So I can 

tell you that as severe as those injuries were, we weaned them off. 

I had a severely broken bone in both of my arms. I was off of 

painkillers in three days and never on opioids. So I hope that answers your question. I think anything more than that really needs 

to be carefully looked at. 

Mr. GROTHMAN. Now, are you a mental health professional? I’m 

sorry, are you a health professional? 

Ms. JACOBS. Am I? No. I am a mom of four kids. I think I probably know a whole lot of things. 

Mr. GROTHMAN. No wonder you have so much common sense. 

Ms. JACOBS. I could be a mental health professional by the time 

I raise four children. 

Mr. GROTHMAN. Good. We got one commonsense answer out of 

the five, and it was the person who is not a mental health professional—not a health professional. 

Thank you very much. 

Mr. MICA. I thank the gentleman. 

Mr. Gowdy? 

Mr. GOWDY. Thank you, Mr. Chairman. 

I want to thank all of our panelists, and I want to thank my 

friend from Maryland for his gracious invitation, which I will take 

him up on. I would love to go see what is happening in Baltimore. 

I expect, Mr. Chairman, that it is, at least on a larger scale, similar 

to what was happening in my own home town, which is why I 

started a drug court in 2000, and in addition to that drug court we 

started a drug court for expectant mothers who were using controlled substances during the course of their pregnancy, because I 

do believe getting them off drugs is infinitely preferable to incarceration in non-violent cases. 

I would also say this, Mr. Chairman, and to my friend from 

Maryland, there is no joy like going to a graduation ceremony for 

those who have concluded drug court successfully. I have had folks 

that I prosecuted stop me in the grocery store to show me the certificate from their graduation, and they were prouder of that than 

anything you or I could have ever accomplished in our careers. I 

used to counsel folks who were still going to need prison, so I would 

be a little reluctant to close all the prisons as we open up drug 

courts. 

But the gentleman from Maryland is right. I would say about 

half the crime we saw for 16 years, drugs and/or alcohol were at 


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the root of that. There was one addict in particular, Mr. Chairman, 

who took a hammer to the older couple that lived next to him and 

beat them. They were in bed, asleep, in the middle of the night, 

and he broke in to rob them, and he beat them with a hammer 

where they were unrecognizable as humans. That was the pathologist’s description, not mine. And then he raped the female victim 

post-mortem. He was an addict. 

But we are going to need to hang onto those prisons, Mr. Chairman, in addition to the drug courts, and I would be happy to go 

to Maryland with my friend to see the work that they are doing 

there, and I would invite him down to Spartanburg. 

Drug courts can save people’s lives and get them off. I just hope 

they get off before they do acts of violence against the innocent 

public, because the addicts sometimes leave a wake of violence and 

mayhem in the wake of their addiction. 

With that, I would yield back. 

Mr. CUMMINGS. Would the gentleman yield, please, just for one 

second? 

Mr. GOWDY. Be happy to. 

Mr. CUMMINGS. First of all, I want to thank you for agreeing to 

come to Baltimore. I agree to go to South Carolina, be happy to. 

Just one thing, Mr. Chairman. I agree with you, we have very 

effective drug courts in Maryland, and I know what you are talking 

about. One of my first cases was a death penalty case, early in my 

career, where a young man hammered his grandmother to death, 

and he was on drugs. So I get it, I get it. 

Like I said, I think there are different categories here of folks, 

and I swear, I just wish we could catch them early, like you said, 

because I have seen some really bad, bad stuff. So the thing is trying to figure out a balance here. And even when you figure out the 

balance, you are probably going to still find people falling through 

the cracks, but I guess we have to use our best science and best 

judgment. 

But I thank the gentleman for yielding. 

Mr. GOWDY. Yes, sir. 

Mr. MICA. I thank the members for participating, and our witnesses. 

I just have a couple of final things. 

It is now 1 o’clock. We started this some three hours ago. Fifteen 

people in the United States have died from drug overdoses, three 

of them from heroin. Before the day is over, 120 Americans will 

die, 24 of them from heroin. 

We have heard different things touted here today. Some people 

have said we just need to put more money into treatment. Treatment is essential, but treatment is at the end of the line. 

You heard a couple of comments from the other side of the aisle 

today that we need to act before we go home at Easter and put 

more money into the heroin and drug overdose situation. 

This is the remarks of Senator Grassley on the floor. ‘‘According 

to the Office of National Drug Control Policy, the appropriations 

act passed in December provided more than $400 million in funding specifically to address the opioid epidemic. This is an increase 

of $100 million over the previous year.’’ That is a 25 percent increase, okay? None of that money, when he said that just a few 


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months ago, has been spent yet. All of that money is available 

today. Is that right? Or most of it? Tell me. Most of that money 

is available today, and you would think we were going out of here 

not providing money—25 percent increase. 

I want this in the record, and then let’s put in the record too the 

record of how much was asked for, how much was appropriated, 

how much money was taken from interdiction and law enforcement 

and put into treatment, okay? These are just the facts. We don’t 

want to deal with the facts, but we are going to put this also in 

the record so you can see that, again, there is money there. 

And I want a report. I want a report, I am telling you, this week, 

of how much money is spent, and I want that in the record, okay 

Mr. Botticelli? And then I want something from you, too, Ms. Director of our Mental Health and Substance Abuse office. I want to see 

how much money is pending, and I want it in the record, and I 

want it in my office by Friday close of business, because I know the 

money is there. It hasn’t even been distributed. 

So we are not going to play these games. I want the facts there, 

and we need to stop this stuff at our border. It is coming in, and 

I just showed—my mayor I think also cited it. It is coming in by 

the boatload across the borders. 

I have one question, too. I talked about El Chapo. The biggest 

drugs are coming across the border like it was some kind of a vacation holiday. I was told, speaking of weapons which are used in 

most drug offenses, most of the murders are—in Baltimore, they 

are killing people in drugs. In Orlando, we are killing them—we 

kill them at the mall, we kill them in our streets, in our great communities, our poor communities. We are killing them. Most of them 

are gun deaths, and they are related to drug trafficking, aren’t 

they, Mr. Milione? 

Mr. MILIONE. Yes —— 

Mr. MICA. Yes, and a lot of those are illegal weapons. Now I am 

told—I just got this this morning—El Chapo, who is coming back 

and forth, also one of the weapons he had was traced to the Fast 

and Furious. So it was a weapon that was supplied by the United 

States Government, and the principal drug trafficker who is trafficking across the border like a holiday visit, he had one of the Fast 

and Furious. Are you aware of that? 

Mr. MILIONE. I am aware from the press reports. 

Mr. MICA. Okay. Can you confirm that also for the committee? 

Mr. MILIONE. I wouldn’t be in the best position to do that. It 

would be another agency. I will take it back to the Department. 

Mr. MICA. All right. Well, I want you to check on it for me and 

let me know, okay? 

And I am very pleased with the people out there, but I met with 

some of your people, and the prosecutions are not what they should 

be. You know, you go to Singapore and they do not have a treatment program. I want to put you out of business, Ms. Wen, all the 

treatment programs. I want to put them out of business because 

our kids and our adults should not have to go to treatment. But 

we are allowing this crap to come into the United States. It is offensive. 

We are killing tens of thousands, folks, and anything else, people 

would be outraged. Where are you? Just Say No, and saying Just 


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Say Maybe, there are consequences, or Just Say Okay makes a difference to our young people and what is happening. 

You can tell I can get a little hot, the Italian comes out of me, 

but I have seen them. I have seen them dying in the streets of Baltimore, and I see them now dying again in my community, and we 

need to do something about it, and that supply has to be cut off. 

Then I can put Ms. Wen and others out of business. We won’t have 

to be treating people. We won’t have the scourge on our streets. 

There being no further business before this committee of the 

House, this hearing is adjourned. 

Thank you, witnesses. 

[Whereupon, at 1:10 p.m., the committee was adjourned.] 


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160 


KING-6430 with DISTILLERInsert offset folio 98 here 26064.098
161 


KING-6430 with DISTILLERInsert offset folio 99 here 26064.099
162 


KING-6430 with DISTILLERInsert offset folio 100 here 26064.100
163 


KING-6430 with DISTILLERInsert offset folio 101 here 26064.101
164 


KING-6430 with DISTILLERInsert offset folio 102 here 26064.102
165 


KING-6430 with DISTILLERInsert offset folio 103 here 26064.103
166 


KING-6430 with DISTILLERInsert offset folio 104 here 26064.104
167 


KING-6430 with DISTILLERInsert offset folio 105 here 26064.105
168 


KING-6430 with DISTILLERInsert offset folio 106 here 26064.106
169 


KING-6430 with DISTILLERInsert offset folio 107 here 26064.107
170 


KING-6430 with DISTILLERInsert offset folio 108 here 26064.108
171 


KING-6430 with DISTILLERInsert offset folio 109 here 26064.109
172 


KING-6430 with DISTILLERInsert offset folio 110 here 26064.110
173 


KING-6430 with DISTILLERInsert offset folio 111 here 26064.111
174 


KING-6430 with DISTILLERInsert offset folio 112 here 26064.112
175 


KING-6430 with DISTILLERInsert offset folio 113 here 26064.113
176 


KING-6430 with DISTILLERInsert offset folio 114 here 26064.114
177 


KING-6430 with DISTILLERInsert offset folio 115 here 26064.115
178 


KING-6430 with DISTILLERInsert offset folio 116 here 26064.116
179 


KING-6430 with DISTILLERInsert offset folio 117 here 26064.117
180 


KING-6430 with DISTILLERInsert offset folio 118 here 26064.118
181 


KING-6430 with DISTILLERInsert offset folio 119 here 26064.119
182 


KING-6430 with DISTILLERInsert offset folio 120 here 26064.120
183 


KING-6430 with DISTILLERInsert offset folio 121 here 26064.121
184 


KING-6430 with DISTILLERInsert offset folio 122 here 26064.122
185 

Æ 


KING-6430 with DISTILLERInsert offset folio 123 here 26064.123