S. Hrg. 115–193 

STOPPING THE SHIPMENT OF SYNTHETIC 

OPIOIDS: OVERSIGHT OF U.S. STRATEGY TO 

COMBAT ILLICIT DRUGS 

HEARING 

BEFORE THE

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

OF THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

MAY 25, 2017 

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

Printed for the use of the 

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27–391 PDF 2018

S. Hrg. 115–193 

STOPPING THE SHIPMENT OF SYNTHETIC 

OPIOIDS: OVERSIGHT OF U.S. STRATEGY TO 

COMBAT ILLICIT DRUGS 

HEARING 

BEFORE THE

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

OF THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

MAY 25, 2017 

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

Printed for the use of the 

Committee on Homeland Security and Governmental Affairs 

( 
(II) 

COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

RON JOHNSON, Wisconsin, Chairman 

JOHN MCCAIN, Arizona 

ROB PORTMAN, Ohio 

RAND PAUL, Kentucky 

JAMES LANKFORD, Oklahoma 

MICHAEL B. ENZI, Wyoming 

JOHN HOEVEN, North Dakota 

STEVE DAINES, Montana 

CLAIRE MCCASKILL, Missouri 

THOMAS R. CARPER, Delaware 

JON TESTER, Montana 

HEIDI HEITKAMP, North Dakota 

GARY C. PETERS, Michigan 

MAGGIE HASSAN, New Hampshire 

KAMALA D. HARRIS, California 

CHRISTOPHER R. HIXON, Staff Director 

MARGARET E. DAUM, Minority Staff Director 

LAURA W. KILBRIDE, Chief Clerk 

BONNI DINERSTEIN, Hearing Clerk 

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS 

ROB PORTMAN, Ohio Chairman 

JOHN MCCAIN, Arizona 

RAND PAUL, Kentucky 

JAMES LANKFORD, Oklahoma 

STEVE DAINES, Montana 

THOMAS R. CARPER, Delaware 

JON TESTER, Montana 

HEIDI HEITKAMP, North Dakota 

GARY C. PETERS, Michigan 

ANDREW DOCKHAM, Staff Director and General Counsel 

JOHN KILVINGTON, Minority Staff Director 

KATE KIELCESKI, Chief Clerk 
(III) 

C O N T E N T S 

Opening statements: Page 

Senator Portman .............................................................................................. 1 

Senator Carper ................................................................................................. 5 

Senator Klobuchar ............................................................................................ 8 

Senator Lankford .............................................................................................. 19 

Senator McCaskill ............................................................................................ 24 

Senator Hassan ................................................................................................. 29 

Senator Tester .................................................................................................. 32 

Senator Daines ................................................................................................. 34 

Senator Heitkamp ............................................................................................ 36 

Senator Peters .................................................................................................. 55 

Prepared statements: 

Senator Portman .............................................................................................. 65 

Senator Carper ................................................................................................. 72 

WITNESSES 

THURSDAY, MAY 25, 2017 

Hon. Gregory D. Thome, Director, Office of Specialized and Technical Agencies, Bureau of International Organization Affairs, U.S. Department of 

State ...................................................................................................................... 11 

Robert Cintron, Vice President, Network Operations Management, United 

States Postal Service ........................................................................................... 13 

Robert E. Perez, Executive Assistant Commissioner, Office of Operations Support, U.S. Customs and Border Protection, U.S. Department of Homeland 

Security ................................................................................................................. 14 

Tammy L. Whitcomb, Acting Inspector General, United States Postal Service, 

Office of Inspector General .................................................................................. 16 

Norm T. Schenk, Vice President, Global Customs Policy and Public Affairs, 

United Parcel Service .......................................................................................... 17 

Thomas P. Gilson, M.D., Medical Examiner, Cuyahoga County Medical Examiner, Cleveland, Ohio ........................................................................................... 42 

Hon. Michael Botticelli, Executive Director, Grayken Center for Addiction 

Medicine, Boston Medical Center ....................................................................... 46 

Terry L. Horton, M.D., Chief Division of Addiction Medicine, and Medical 

Director, Project Engage, Christiana Care Health System, Wilmington, 

Delaware ............................................................................................................... 48 

Thomas Synan, Jr., Chief of Police, Newtown, Ohio, Police Department ........... 50 

ALPHABETICAL LIST OF WITNESSES

Botticelli, Hon. Michael: 

Testimony .......................................................................................................... 46 

Prepared statement .......................................................................................... 146 

Cintron, Robert: 

Testimony .......................................................................................................... 13 

Prepared statement .......................................................................................... 86 

Gilson, Thomas P.: 

Testimony .......................................................................................................... 42 

Prepared statement with attachments ........................................................... 113 

Horton, Terry L. M.D.: 

Testimony .......................................................................................................... 48 

Prepared statement .......................................................................................... 152 

Perez, Robert E.: 

Testimony .......................................................................................................... 14 
Page

IV 

Perez, Robert E.—Continued 

Prepared statement .......................................................................................... 92 

Schenk, Norm T.: 

Testimony .......................................................................................................... 17 

Prepared statement .......................................................................................... 106 

Synan, Thomas Jr.,: 

Testimony .......................................................................................................... 50 

Prepared statement .......................................................................................... 157 

Thome, Hon. Gregory D.: 

Testimony .......................................................................................................... 11 

Prepared statement .......................................................................................... 82 

Whitcomb, Tammy L.: 

Testimony .......................................................................................................... 16 

Prepared statement .......................................................................................... 101 

APPENDIX 

Responses to post-hearing questions for the Record from: 

Mr. Thome ......................................................................................................... 161 

Mr. Cintron ....................................................................................................... 173 

Mr. Perez ........................................................................................................... 199 

Ms. Whitcomb ................................................................................................... 238 
(1) 

STOPPING THE SHIPMENT OF SYNTHETIC 

OPIOIDS: OVERSIGHT OF U.S. STRATEGY TO 

COMBAT ILLICIT DRUGS 

THURSDAY, MAY 25, 2017 

U.S. SENATE,

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS,

OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 9:33 a.m., in room 

SD–342, Dirksen Senate Office Building, Hon. Rob Portman, Chairman of the Subcommittee, presiding. 

Present: Senators Portman, Lankford, Daines, Carper, Tester, 

Heitkamp, and Peters. 

Also present: Senators McCaskill, Klobuchar, and Hassan. 

OPENING STATEMENT OF SENATOR PORTMAN 

Senator PORTMAN. The Committee will come to order. We will get 

started. We have a great group of Members who are here, and everybody has a lot of different commitments this morning. We also 

are very eager to hear from our witnesses and talk about a critical 

issue facing our country. 

It is really a crisis in our communities, and it is getting worse, 

not better. The crisis is the opioid epidemic. Our country is being 

gripped by it. My State is, as are the States of every Senator 

around the table. 

It is a crisis that does not discriminate. It is in every corner of 

my State. Earlier this month, a police officer named Chris Green 

in East Liverpool, Ohio, had a near-fatal fentanyl overdose following a routine traffic stop. He went up to a car for a routine stop 

and noticed there was white powder spread around the car. He did 

the right things. He put on his mask, he put on his gloves, and arrested some individuals. 

He went back to the police station, and he noticed that on his 

shirt there was some powder, so he reached up and brushed the 

powder off his shirt. This guy is 6-foot-3, 225 pounds, a big man, 

and he fell to the floor unconscious and overdosed. They administered Narcan immediately, but it was not enough. They had to rush 

him to the hospital where two more Narcan doses were administered, and luckily, his life was saved. As his police chief said, he 

would have died had he been alone. The police chief also said, 

‘‘What if he had gone home with that powder on his shirt and 

hugged his kid?’’ 
2 

That is just an example of what we are facing. It is obviously 

devastating our communities and families, but also creating quite 

a danger for our law enforcement and other first responders. 

Fentanyl is 30 to 50 times more powerful than heroin and 100 

times stronger than morphine, and a lethal dose can be as little as 

two milligrams. We had some floor speeches this week about it. We 

were able to show that just a tiny amount of fentanyl can be deadly. We also know about U–4 and carfentanil and other synthetic 

drugs that are coming into our country. 

This issue is getting worse. As I said, the number of overdoses 

and deaths have increased dramatically. Earlier this month, you 

may have seen that the Director of National Intelligence (DNI), 

Dan Coats, our former colleague, actually included synthetic 

opioids in his World Wide Threat Assessment, and he noted in his 

comments that deaths had increased 73 percent just between 2014 

and 2015, the last year for which they have records. So sadly, that 

death toll continues to climb, and we will hear about that this 

morning. 

In one county in Ohio, for instance, fentanyl was responsible for 

394 overdose deaths in 2016. One county. Tom Gilson, whom you 

will hear from later, the Cuyahoga medical examiner (ME), will tell 

you he is projecting 581 fentanyl-related deaths out of 850 total 

fatal drug overdoses this year. In other words, fentanyl is by far 

our biggest killer. 

A lot of these deaths are due to mixing fentanyl with heroin and 

other drugs, leaving the user with no idea what they are taking. 

An example of this is a new opioid cocktail called ‘‘gray death.’’ 

Gray death includes a mixture of heroin, fentanyl, carfentanil, and 

U–4770. Heroin is the weakest drug in that mix. Think about that. 

This is available on the street, this opioid cocktail, for as little as 

$10 to $20. Even though these drugs are selling very inexpensively, 

fentanyl has a extremely high profit margin, making it appealing 

to the drug dealer. 

The Drug Enforcement Agency (DEA), estimates that a kilogram 

of fentanyl can be purchased from a Chinese supplier for a few 

thousand dollars. A kilogram for a few thousand dollars can be 

used to make hundreds of thousands of pills with profits in the millions. 

So, bottom line, we need to stop this flow of illegal, illicit 

fentanyl. And, unbelievably, it comes through the U.S. mail system. 

This is a shock to many of my constituents and others who are 

learning about this. While some of this fentanyl is smuggled into 

the United States from Mexico and Canada, primarily it comes directly into the United States. According to law enforcement, including some folks who are here this morning who will tell us about 

this, it primarily comes from one place, which is China. It is produced in laboratories there, and our understanding from law enforcement is that most of that fentanyl produced in China is intended for export to one place, and that is the United States of 

America. 

There are a number of Chinese websites ready to ship. Do a 

Google search for ‘‘fentanyl for sale,’’ and it produces a number of 

websites where the drug—and many others—appear to be readily 

available. 
3 

On one website, you can purchase a gram of fentanyl for $250, 

but it says, ‘‘The more you buy, the less you pay,’’ offering discounts for larger volumes. 

To ease any concern about whether the purchaser would receive 

his order, the website guarantees discreet shipment ‘‘with 

undetectable and careful packaging.’’ 

While shipment was available to any number of countries, the 

website knew its audience and offered express delivery to the 

United States. Many of these websites are so sure that their shipment will not be stopped by law enforcement that they will guarantee that if the original somehow gets lost or seized, they will 

send you another one for free. 

Several websites we reviewed made it clear they exclusively used 

Express Mail Service (EMS), as their courier. EMS, of course, is 

the international postal service offered by members of the Universal Postal Union (UPU). Packages delivered through EMS are 

passed to the United States Postal Service (USPS) as they enter 

the United States. 

So, our shared goal today is to try to stop these drugs from exploiting our own streams of mail into our country. Every Member 

around this dais this morning has been involved in this issue on 

prevention and education, on treatment and recovery. We have actually passed two significant new legislative initiatives in the last 

year in this Congress focused on this issue. We understand it is 

much broader than just interdicting, but we have to do a better job 

of interdicting. 

Following September 11, 2001 (9/11), Congress identified weaknesses in international shipping standards as a significant problem 

and made clear that requiring advance electronic data (AED) would 

make our country safer. This was 15 years ago. But when Congress 

first legislated, it did so, however, and left a gaping loophole. 

The Trade Act of 2002 mandated that commercial carriers provide advance electronic data that could be used to identify certain 

packages being shipped into the United States. In that 2002 legislation, Congress asked the Secretary of Homeland Security and the 

Postmaster General to decide if the Postal Service should be subject to the same requirements that they were putting in place for 

all private carriers. To date, no determination has been made, and 

our country is less safe as a result. 

As such, the difference between the information that private 

commercial carriers are required to provide is very different from 

the Postal Service, but both serve the same function: delivering 

packages into our communities. 

At the same time, the Postal Service handles a much higher volume of international packages than the commercial carriers combined. 

Prior to any shipment arriving in the United States, commercial 

carriers are required to electronically provide data to law enforcement, including Customs and Border Protection (CBP), with the 

basic information, including: what the shipper name and address 

is; the name and address of the person receiving the package; a description of the contents; the piece count; the weight; and the value 

of the contents. This information is then transmitted to Customs 

and Border Protection and 47 other Federal agencies at the Na-
4 

tional Targeting Center. Based on this information, CBP targets 

suspect shipments for additional scrutiny and selects the packages 

it wants to inspect when they arrive in the United States. 

Commercial carriers are also charged $1 per package by CBP 

which most commercial carriers pass on to the shipper. None of 

this applies to the Postal Service, and the Postal Service handles 

hundreds of thousands of packages every day. 

All international packages shipped through the Postal Service 

are routed through five international service centers, with the New 

York center at John F. Kennedy (JFK) Airport receiving the overwhelmingly majority of those packages. How these packages are 

processed is completely different at each of these centers. For the 

most part, CBP is tasked with identifying packages or shipments 

it wants to inspect, and the Postal Service locates those packages 

or shipments and presents them to CBP. 

However, it is not that easy. Due to the hundreds of thousands 

of packages, the Postal Service is left to manually sort through 

large shipments trying to identify what CBP is looking for. All 

internationally shipped packages are already required by the Universal Postal Union to have certain information attached to them 

including: the sender, the recipient, a description of the contents, 

weight, and value. 

The problem is that information is not electronic, and it is not 

transmitted in advance. So it is not useful to law enforcement. Essentially, it is useless. 

The UPU has indicated it will require member countries to place 

a bar code on every package starting in 2018. That is fine. However, the shipper will not be required to load any electronic information on that bar code until 2020. Meanwhile, we have a crisis. 

Realistically, the target date to implement this requirement is 

closer to 2022, we are told, but there is no guarantee that it will 

even happen by then. For 15 years, the Postal Service has been on 

notice of the need to collect advance electronic data about its packages. We cannot wait any longer. As Americans are dying every 

day from these poisonous drugs flowing into our country, we must 

act. And we have to stop this fentanyl, carfentanil, and other synthetics from coming in. 

The Postal Service is trying to use electronic information at JFK 

to help CBP identify these packages. It is a pilot program. The 

Postal Service is providing electronic data to CBP for packages that 

weigh less than 4.4 pounds, so-called ePackets. Once the Postal 

Service shares the information, CBP uses the information to identify the packages it wants to inspect. The Postal Service then locates and presents those selected packages for CBP inspection. 

This is a step in the right direction, in my view. After nearly 15 

years of not doing this, the results to date are lacking, however. 

In December 2016, late last year, the Inspector General (IG) 

found the Postal Service failed to present all of the packages CBP 

selected for inspection and a substantial number of ePackets lacked 

any advance electronic data associated with it. 

I understand the Postal Service is starting to take steps to remedy this issue of presenting packages to CBP for inspection, and I 

look forward to hearing the details of that today. But without ad-
5 

vance electronic data, we will continue to miss a significant portion 

of these packages. 

Further, the pilot program is only happening at one location. At 

the other four centers, the Postal Service is stuck sifting through 

millions of packages, like trying to find a needle in a haystack. We 

cannot continue like this. We need the electronic data, and we need 

it now. 

We have been working in a bipartisan way to solve this problem. 

That is why we introduced legislation called the Synthetic Trafficking and Overdose Prevention (STOP) Act. My co-author is here 

with us today, and she will speak in a moment. It is aimed at providing advance information that the Postal Service should be providing for international mail. 

We have 16 cosponsors in the Senate—eight Democrats and eight 

Republicans. In the House, there is separate, companion legislation 

that has 128 bipartisan cosponsors. Our focus today is getting 

input from this panel of witnesses so we have a clear understanding from all of the key stakeholders as we move forward on 

this. 

Again, thank you all very much for being here. I thank my colleagues for being here. I would now like to turn to the Ranking 

Member, Senator Carper. 

OPENING STATEMENT OF SENATOR CARPER 

Senator CARPER. In the Navy, we talk about special moments. 

We call them ‘‘all hands on deck.’’ This is an ‘‘all hands on deck’’ 

moment for not just those of us in this room, not just in the Senate, 

not just Delaware or Ohio or any other States that are represented. 

This is an ‘‘all hands on deck moment’’ for our country, and we welcome all of our witnesses, this panel and the second panel. 

I want to thank our Chairman and I want to thank Amy 

Klobuchar for the good work that they have done and others on 

this Committee have done to get us ready for this day. 

The focus on today’s hearing is more about at least one of the 

ways these drugs are getting into communities and what we can 

do to stop them. We look forward to hearing from our witnesses on 

the first panel to better understand the processes used by the Postal Service, by private shippers, and by CBP to screen international 

mail shipments and to identify and stop potentially illicit packages. 

I also look forward to learning more about where the coordination between shippers and Federal agencies is working well, while 

identifying areas where we need to push for improvements. 

Joining in today’s discussion is the Postal Service which, in partnership with CBP, is our first line of defense in preventing the flow 

of illegal drugs and contraband into our country. 

As some of you may recall, protecting and improving the mail 

system in this country has been one of our biggest priorities, certainly one of my biggest priorities, on this Committee for a number 

of years. The Postal Service is vital to our economy. It is the 

linchpin of a trillion-dollar mailing industry. Yet, the agency is facing insolvency if Congress does not act in the coming months to 

pass comprehensive postal reform. 
6 

Enacting that legislation will free up billions of dollars that the 

Postal Service can use not only to invest for the future and improve 

customer service, but also shore up mail security. 

It is worth noting that, despite the financial uncertainty facing 

the Postal Service, its inbound international package volume has 

grown significantly in the past three years. In fact, it has nearly 

doubled, growing from 150 million pieces in 2013 to more than 275 

million in 2016. 

There is no question that handling that increased volume, in addition to the increase in domestic packages that we are seeing—we 

welcome that, but it is putting a strain on an already stretched resource. 

Unlike private carriers, the Postal Service is required to deliver 

all mail it receives from foreign posts in a timely manner. This is 

due to our membership in the Universal Postal Union, which sets 

international mailing standards. It also ensures that we can send 

mail ourselves to friends, to families, and to business partners 

overseas. 

The State Department represents the United States at something 

called the Universal Postal Union, and they are going to be here 

with us today to discuss our involvement and their involvement in 

this key organization. We look forward to hearing from our Postal 

Service and State Department witnesses about our commitment to 

promoting the exchange of advance electronic data among the 

Union’s 192 member countries as a means of combating the shipment of drugs and other illegal goods. 

While all packages are screened initially by CBP before being 

presented to the Postal Service, CBP can, and often does, target 

packages for additional screening. CBP, which is also joining us 

today, can target packages based on the country of origin or scans 

done by the Postal Service. Recently, the Postal Service and CBP 

have been working closely together on a pilot program that allows 

CBP to use advance electronic data on small packages from China 

arriving at JFK Airport. 

While the Postal Service provides other countries with advance 

electronic data about mail originating in the United States, we do 

not always get that same information from other countries. This 

makes it harder for CBP to do its job as packages arrive here. The 

pilot program at JFK is a rare exception, so I hope we can learn 

today whether there are any recommendations to improve and expand this program. 

As my colleagues here have heard me say many times, find out 

what works, do more of that. Private carriers, like United Parcel 

Service (UPS)—which is also joining us today—already provide 

CBP with advance electronic data on packages destined for our 

country. And unlike the Postal Service, private carriers have integrated, automated systems in locations around the world and can 

refuse to accept a package at origin that does not contain any shipping manifest data. Learning how this process is yielding success 

in interdicting shipments of illicit drugs can hopefully help us cover 

the gaps exploited by smugglers. 

I also look forward to identifying methods that Congress can ensure that Federal agencies, as well as our State and local partners, 

have the resources that they need to combat the opioid crisis on the 
7 

ground. Specifically, I am eager to hear from our witnesses on the 

second panel, each of whom serve on the front lines of the Nation’s 

opioid epidemic in various capacities, from law enforcement to medical doctors, and addiction experts. These witnesses will give us 

firsthand perspectives of the challenges we face in fighting opioid 

addiction and the strategies that have proven effective, particularly 

in Delaware and Ohio, and nationwide. 

While I look forward to a discussion of ways to reduce Americans’ 

access to and use of synthetic opioids, this is only part of the equation. We must not lose sight of the need to focus on the root causes 

of our Nation’s considerable demand for drugs—not just on the 

symptoms but on the root causes of those considerable demands for 

drugs. Until we do that, the crisis will only continue to worsen and 

smugglers will continue to look for and find ways around the defenses we put in place to block the supply of dangerous drugs. 

Today’s opioid crisis is arguably the worst in American history. 

According to the Centers for Disease Control (CDC), over 33,000 

Americans suffered an opioid-related death in 2015. That is roughly the population of our capital in Dover, Delaware. My home State 

of Delaware has not been immune. None of our States have been 

immune. According to Delaware’s Division of Forensic Science, 

there were 222 overdose deaths in Delaware in 2014, 228 in 2015, 

and last year 308. These numbers are staggering for a little State. 

Unfortunately, they are even worse in some communities in Ohio 

and elsewhere in the States that are represented on this dais. 

Substance abuse is a complex problem with consequences for everyone, and we cannot pay attention only to the symptoms of the 

problem without trying to address the underlying causes. 

We know that overdose deaths are preventable, so as the crisis 

worsens, we need to work together to provide critical and robust 

funding to help save lives. 

In closing, I believe it is critical to note that access to health care 

plays a pivotal role in combating addiction. Unfortunately, current 

proposals to repeal the Affordable Care Act (ACA) threaten to undermine much of the recent bipartisan progress in addressing the 

Nation’s opioid epidemic and strengthening our Nation’s mental 

health system. 

As we all know, Medicaid is the single largest payer of substance 

abuse services in our Nation, paying for one-third of all medicationassisted treatments (MAT). Current plans to repeal Medicaid expansion and add program caps threaten to make this opioid crisis 

worse, as millions will be at risk of losing coverage for substance 

abuse prevention, treatment, and recovery services, at the time we 

need those services the most. 

Going forward, I look forward to working even more effectively 

with our colleagues on both sides of the aisle to address the underlying causes of this opioid epidemic and to learn what we can do 

and how we can bring about substantial, lasting change. 

Thank you so much. Thank you, Mr. Chairman. 

Senator PORTMAN. I thank the Ranking Member. 

As Senator Carper noted, we have one of our colleagues with us 

today who is not on the Committee, and that is Senator Amy 

Klobuchar. She is the co-author of the STOP Act and we appreciate 

her interest in the topic. We welcome her participation and I would 
8 

like to ask unanimous consent that even though she is not a Member of the Committee that she be allowed to participate in today’s 

hearing. And without objection—— [Laughter.] 

That is why I was moving quickly. I was worried. Without objection—— 

Senator MCCASKILL. This is what we are giving her for her birthday. 

Senator KLOBUCHAR. Thank you. 

Senator MCCASKILL. She wanted to come to this hearing since 

today is her birthday. 

Senator PORTMAN. You chose to spend your birthday with us. I 

would like to recognize Senator Klobuchar. Senator Carper and I 

talked about this in advance and for that matter, if other Members 

would like to make a brief opening statement, that is all right. But 

I know she has another markup that she is supposed to be at right 

now. So, Senator Klobuchar, if you would make a few remarks, we 

would appreciate it. 

OPENING STATEMENT OF SENATOR KLOBUCHAR 

Senator KLOBUCHAR. Well, thank you very much Mr. Chairman 

and thank you Senator Carper. It is a very celebratory moment to 

be here with the Subcommittee for my birthday. Thank you. And 

it was really an amazing moment to meet some of the witnesses 

out there and I think you will all really learn a lot by hearing from 

them. I have never heard the coroner speak on this, but the medical examiner here really hits home how dangerous this is. 

We take this personally in my State. We lost Prince to fentanyl, 

and that investigation is still going on and includes finding out 

where he obtained that drug. But it was not just Prince. It is also 

a mom in Rochester, Minnesota, a student in Duluth, and like 

every State we see opioid deaths on the rise, now exceeding homicides in our State. 

I look at this in three ways—when we passed this framework, I 

think we started thinking this way. I want to thank Senator 

Portman for his leadership on that bill and we worked in a bipartisan way with Senator Ayotte and Senator Whitehouse and myself. But, the three things are: 

One, trying to reduce the number of people getting hooked on 

legal opioids and that means everything from our prescription drug 

monitoring bill to the work that we are trying to get changes in 

how prescriptions are given out and how many drugs are given for 

simple things like wisdom teeth. 

The second, of course, is treatment and we did some good work, 

all of us did, with the Cures Act. We are going to have to continue 

to do work with the budget. I appreciate your leadership on the Republican side, Senator Portman, in objecting to these Medicaid cuts 

that we heard from the House. I think that is going to be really 

important. 

But the third is that we all know as people are migrating over 

to the illegal drugs because they are either cheaper or easier to get, 

we are going to see more of these kinds of overdoses from things 

like fentanyl. Just in the last few months in my State, we have had 

11 people die from carfentanil, which is an even more powerful 
9 

form of fentanyl. It is 100 times more potent than fentanyl. A dose 

the size of two grams of salt can be fatal. 

On our Judiciary Committee we heard from Customs just last 

week and the numbers we heard is that in 2013 fentanyl seizures 

were at two pounds and now last year 440 pounds, to give you a 

sense of this tremendous increase. That is why I am proud to be 

the lead Democrat on our bill. Senator Portman and I have the 

STOP Act, which he has described well. I think it is really important that we start using modern technology so that we are as sophisticated in tracking down these perpetrators as the ones that 

are getting our kids hooked and killing people in our country. 

The second thing that I want to mention is the SALTS Act, 

which is a bill I have with Senator Lindsey Graham. It makes it 

easier to prosecute these kinds of cases. I know Senators Heitkamp 

and McCaskill were here earlier as people who worked as prosecutors. They also see this as a real issue because you have drug dealers who are basically changing, sometimes over the Internet, the 

components in these drugs and they are doing it with fentanyl as 

well. And then they make it harder for us to prosecute them, especially in our rural areas where it is not easy to call a medical expert up like we have here today in Washington. 

And so, we are feeling good about this bill because Senator 

Grassley is on it and Senator Feinstein, the two leads of the Judiciary Committee, and we urge others to look at the bill. But it simply 

makes it easier to prove up analogs when they change the composition of synthetics. So that is another thing I would suggest. 

But I mostly want to thank Senator Portman for his leadership 

and his willingness to work across the aisle on this really important issue, and thank you as always, Senator Carper. Thanks. 

Senator PORTMAN. Thank you, Senator Klobuchar. 

Would any other Members like to make brief opening statements? 

[No response.] 

All right. We are going to go to our first panel of witnesses, and 

we have a very distinguished panel. Some of you were here for a 

roundtable in this very location last year where, frankly, the STOP 

Act first originated, because we were able to identify this problem. 

I would like to call the witnesses individually. 

First, Gregory Thome, thank you for being here, Director of the 

Bureau of International Organization Affairs at the State Department, which, of course, works to advance U.S. national interests 

through multilateral engagements. Prior to joining the State Department in 1991 here in Washington, he held senior Foreign Service positions in Morocco, Iraq, Finland, Brazil, and other countries. 

Robert Cintron is here. Robert Cintron is the Vice President of 

Network Operations at the Postal Service. Mr. Cintron began his 

Postal Service career 31 years ago as a clerk in Rochester, New 

York. In his current role, he oversees the Postal Service’s distribution network, including overall network design, policies, and programs for processing sites, logistics required to move mail, and 

maintenance policies and programs that support the postal network. 

Third, we have Robert Perez here. Robert is the Acting Assistant 

Commissioner Operations Support at U.S. Customs and Border 
10 

Protection. Previously, Mr. Perez served as director of Field Operations for CBP’s New York Field Office where last year he oversaw 

the arrival of more than 21 million international travelers and 

$240 million in imported goods. Over the course of his distinguished career, Mr. Perez has represented CBP as a border security expert all over the world at many different international business conferences, on official assignments, and as a guest lecturer 

as a border security expert. 

We have Tammy Whitcomb with us today, who is the Acting Inspector General for the U.S. Postal Service. Ms. Whitcomb came to 

the Postal Service as an audit director in 2005, and has served as 

Deputy Inspector General since 2011. Prior to her time at the post 

office, she also worked at both Internal Revenue Service (IRS) Inspection Service and the U.S. Department of Treasury Inspector 

General for Tax Administration. 

And, finally, we have Norm Schenk with us today. Norman 

Schenk is the vice president of Global Customs Policy and Public 

Affairs for the United Parcel Service (UPS). With UPS, Mr. Schenk 

has spent the last 30 years working directly with government leaders around the world on reducing trade barriers, simplifying customs processes, and most recently with supply chain security 

issues. Mr. Schenk previously testified to Congress on drug enforcement issues and he currently serves on advisory committees to the 

World Customs Organization and the U.S. Department of Commerce. Mr. Schenk also currently chairs the International Chamber 

of Commerce Commission on Customs and Trade. 

Again, I appreciate every one of our witnesses being here this 

morning, and we look forward to hearing your testimony. It is the 

custom of this Subcommittee to swear in the witnesses, so at this 

time I would ask you to please stand and raise your right hand. 

Do you swear the testimony you will give before this Committee 

will be the truth, the whole truth, and nothing but the truth, so 

help you, God? 

Mr. THOME. I do. 

Mr. CINTRON. I do. 

Mr. PEREZ. I do. 

Ms. WHITCOMB. I do. 

Mr. SCHENK. I do. 

Senator PORTMAN. Thank you. Please be seated. 

I would note that all of the witnesses indicated that they were 

prepared to testify under oath, and let the record reflect that they 

all answered in the affirmative. Your written testimony will be 

made part of the record, and I would ask you to try to keep your 

oral comments to five minutes each so that we can get to the questions. 

Mr. Thome, I would like to start with you. 
11 

1The prepared statement of Mr. Thome appears in the Appendix on page 82. 

TESTIMONY OF THE HONORABLE GREGORY D. THOME,1 DIRECTOR, OFFICE OF SPECIALIZED AND TECHNICAL AGENCIES, BUREAU OF INTERNATIONAL ORGANIZATION AFFAIRS, 

U.S. DEPARTMENT OF STATE 

Mr. THOME. Thank you, Chairman Portman, Ranking Member 

Carper, Members of the Subcommittee. Good morning and thank 

you again for the opportunity to appear today to discuss the issue 

of illicit drugs, including synthetic opioids, in international mail. 

The supply side of the synthetic opioid crisis presents a complicated picture with multiple pathways for these drugs to enter 

the country. In addition to shipments that find their way into the 

United States from across our land borders and through express 

delivery services (EDS), illicit fentanyl and other illicit drugs also 

enter the country through international mail, typically in small 

shipments purchased online by individual customers. 

The Department of State is aware that these small shipments 

pose unique challenges to U.S. Customs and Border Protection— 

challenges that the exchange of advance electronic data can help 

mitigate. Consequently, the Department of State works closely with 

CBP and the U.S. Postal Service to take steps, at the global level, 

to increase the availability of advance electronic information (AEI) 

for international mail. And we are committed to helping enhance 

CBP’s ability to interdict drugs in this channel. 

Before discussing these efforts, I should explain that the Postal 

Accountability and Enhancement Act of 2006 identifies the Department as the lead agency for international postal policy. The main 

forum for our work is the Universal Postal Union. The UPU is an 

intergovernmental organization of 192 countries that have committed to delivering one another’s mail on the basis of reciprocity. 

The UPU Congress and its 40-member Postal Operations Council 

(POC), write and adopt the Acts of the Union, which are the rules 

of the road for international mail exchange. At the UPU Congress 

of 2012, the United States was successful in securing amendments 

to the UPU Convention that committed each member State to 

adopt and implement a security strategy which includes complying 

with requirements for providing AEI. 

And at the most recent UPU Congress in 2016, the United States 

was re-elected to the POC and was selected to co-chair the POC’s 

Committee on Supply Chain. This committee oversees all UPU 

work on customs, security, transportation, and standards. The 

United States also chairs the Committee’s Standing Group on Postal Security. These leadership roles position us extremely well to ensure that high priority security issues—especially AEI—move forward as quickly as possible. And we have made significant progress 

toward that goal. 

With active participation and technical input from the United 

States, the UPU cooperated with the World Customs Organization 

to develop an electronic data system to allow for the capture, transmission, and receipt of AEI. In February of last year, the POC 

adopted a new regulatory framework for the exchange of AEI called 

the ‘‘Roadmap for AEI Implementation.’’ The United States now 

leads the steering committee coordinating the work required to 
12 

reach the roadmap’s milestones, which include final adoption of the 

technical messaging standard for item-level data. Adoption of that 

standard should take place at this fall’s POC meeting. 

As significant as these achievements are, they are only part of 

the picture and there are obstacles to overcome. The main impediment to widespread AEI is the limited ability of most postal services to collect and transmit it. The UPU Business Plan adopted in 

2016 calls for all postal services to have the capability to exchange 

item-level data by the end of 2020. 

However, the technical ability to exchange this data does not 

translate directly into the ability to collect or enter it. Many post 

offices in the developing world do not have Internet connectivity or 

even reliable sources of electricity, which makes collection of data 

and transmission of data extremely difficult. And even in developed 

countries, some postal services have been slow to invest in the 

needed infrastructure for item-level electronic data exchange. Currently few, if any, countries have the ability to provide it for 100 

percent of their mail requiring customs declarations. 

Our approach has been to support the UPU to provide capacity 

building that enables AEI. The UPU is devoting half of its cooperation budget over the next four years to a project designed to position postal services in developing countries to obtain this capacity. 

And the major focus of this program is AEI. 

We will continue to support and encourage these efforts but recognize that rapid acceleration of investment in, and use of, electronic data for customs and security will also be driven by the business needs of postal operators themselves. Postal operators now understand that delays caused by necessary customs processing are 

a major impediment to their own ability to grow their business 

model and adapt to the rapid growth of e-commerce transactions. 

Exchange of AEI is the only real solution to this problem. Consequently, while the United States was once a voice in the wilderness almost alone in calling for AEI exchange, we are now leading 

a chorus of countries—developing and developed—that demand 

AEI. 

Another significant development with implications for AEI is the 

UPU’s decision to launch the Integrated Product Plan (IPP), which 

aims to modernize UPU product offerings with an eye toward ecommerce. This far-reaching effort has clear benefits for the customs processing of mail. Phase 1, which begins in January 2018, 

will introduce segregation of mail into items containing documents 

and those containing goods. This split will facilitate compliance 

with customs requirements, including AEI. Phase 1 also requires 

mail items containing goods to have a UPU standard bar code 

label, which is critical to enabling AEI. 

Furthermore, UPU approved regulations in February 2016 which 

will allow members to impose AEI requirements on items containing goods, provided they take into account whether the requirements they are imposing can be met by those to whom they apply. 

The thinking behind the regulation was that demanding something 

that is impossible immediately as a condition for delivering another 

country’s mail is the same as refusing to receive it at all. Such a 

requirement would undermine the reciprocity that is at the heart 

of the UPU. 
13 

1The prepared statement of Mr. Cintron appears in the Appendix on page 86. 

In conclusion, I would like to assure the Subcommittee that the 

State Department is fully committed to accelerating all countries’ 

ability to provide AEI. To that end, we will spare no effort to ensure swift implementation of the UPU Roadmap and the Integrated 

Product Plan. As these programs move forward, we are confident 

that the number of countries able to provide AEI and the portion 

of their mail stream that it covers will continue to grow. 

Thank you Mr. Chairman. I look forward to answering your 

questions. 

Senator PORTMAN. Thank you, Mr. Thome. Mr. Cintron. 

TESTIMONY OF ROBERT CINTRON,1 VICE PRESIDENT, 

NETWORK OPERATIONS, UNITED STATES POSTAL SERVICE 

Mr. CINTRON. Good morning, Chairman Portman, Ranking Member Carper, and Members of the Subcommittee. Thank you, Chairman Portman, for calling this hearing. 

My name is Robert Cintron. I am the Vice President, Network 

Operations, for the United States Postal Service. I oversee the 

Postal Service’s national distribution network, including its international operations. 

Congress has given U.S. Customs and Border Protection the responsibility and authority to screen items at the first point of entry 

into the United States. At entry, Customs has the authority to 

open and inspect all inbound items without a warrant to identify 

prohibited items. 

Inbound international mail from foreign postal operators arrives 

by plane at one of our International Service Centers (ISCs). It typically arrives in large bags packed in containers. After an initial 

bulk screening by Customs, inbound shipments receive an initial 

receipt scan by the Postal Service. At this point, items requested 

by Customs are presented for further inspection. 

For those items for which advance electronic data is furnished, 

Customs has an enhanced ability to target items for inspection. 

Today the Postal Service collects AED for more than 90 percent 

of its outbound international packages and receives 40 to 50 percent of this information for inbound packages. To put this in perspective, comparing data from fiscal year (FY) 2015 to the present, 

AED for inbound international packages has increased from approximately one percent to its present range, between 40 and 50 

percent. In other words, the Postal Service currently receives data 

on a substantial amount of inbound shipments, including those 

originating in China. 

The percentage of inbound items with AED is expected to continue to grow, especially as more countries develop their capacities. 

In an effort to further expand the provision of AED for international inbound volume, the Postal Service is prioritizing obtaining AED from the largest volume foreign postal operators, which 

collectively account for over 90 percent of all inbound volumes. 

For example, we have entered into bilateral agreements that require AED with foreign postal operators of China, Korea, Hong 

Kong, and Australia. And we have entered into voluntary data- 
14 

1The prepared statement of Mr. Perez appears in the Appendix on page 92. 

sharing agreements with more than 30 foreign posts to facilitate 

the exchange of AED. 

Additionally, the Postal Service has a pilot program in our New 

York ISC that allows Customs to use inbound AED for more advance targeting. With the lessons learned from this pilot, we are 

working with Customs to expand this approach to our other ISCs. 

Unlike private companies, the Postal Service must accept and deliver mail from nearly every country in the world. The Postal Service does not control the induction of foreign mail destined for the 

United States, so we cannot control the collection of AED abroad. 

However, the Postal Service, in collaboration with the State Department and Customs, plays a leadership role in advocating for 

the global collection and exchange of AED. 

Through negotiation and advocacy and by targeting nations with 

greater capacity like China, inbound AED has grown enormously 

in the past few years. 

In conclusion, we share your concerns about America’s opioid epidemic and we continue to work with Customs to enhance the interdiction of illegal drugs and contraband. The post is committed to 

taking all practicable measures to ensure our Nation’s mail security and provide the American public the best and most efficient 

service possible. 

Again, thank you for this chance to testify, and I look forward 

to your questions. 

Senator PORTMAN. Thank you, Mr. Cintron. Mr. Perez. 

TESTIMONY OF ROBERT E. PEREZ,1 EXECUTIVE ASSISTANT 

COMMISSIONER, OFFICE OF OPERATIONS SUPPORT, U.S. 

CUSTOMS AND BORDER PROTECTION, U.S. DEPARTMENT OF 

HOMELAND SECURITY 

Mr. PEREZ. Good morning, Chairman Portman, Ranking Member 

Carper, and distinguished Members of the Subcommittee. Thank 

you for the opportunity to appear today to discuss the role of U.S. 

Customs and Border Protection in combating the flow of dangerous 

synthetic opioids, particularly fentanyl, into the United States. 

The majority of fentanyl smuggled into the United States is done 

so through international mail facilities, express consignment carrier facilities, or through our ports of entry along the Southern 

land border. 

In fiscal year 2016, CBP officers and agents seized or disrupted 

more than 3.3 million pounds of narcotics. CBP seizures of fentanyl 

remain relatively small, but have significantly increased over the 

past few years, from two pounds seized in 2013 to over 400 pounds 

seized in 2016. Fentanyl is the most frequently seized illicit synthetic opioid. 

Along the Southern border, heroin is often spiked with fentanyl. 

Fentanyl is also sometimes spiked with other substances and sold 

as synthetic heroin. Drug-trafficking organizations continually 

adapt to evade detection and interdiction by law enforcement. 

CBP uses the same drug interdiction methods to seize fentanyl 

as it uses to detect other drugs coming across the border. However, 

the detection of fentanyl remains challenging due to the limited 
15 

field testing capabilities and the variety of fentanyl analogs on the 

market. 

In the express consignment environment, CBP can place an electronic hold and notify carriers that a parcel needs to be presented 

to CBP for inspection. CBP is working to implement the same system in the international mail environment. Together with the 

United States Postal Service, we have been conducting an advance 

data pilot on express mail and e-packets from some countries. We 

continue to work with the U.S. Postal Service to address the issue 

of electronic advance data. 

Thanks to the support of Congress, CBP has made significant investments and improvements in our drug detection technology and 

targeting capabilities. For example, at the National Targeting Center, CBP leverages advance information alongside law enforcement 

and intelligence records to identify smuggling trends and target 

shipments that may contain illicit substances or related equipment 

being diverted for illicit use, such as pill presses, tablet machines, 

or precursor chemicals. 

In addition to their experience, training, and intuition, CBP officers and agents use various forms of technology and equipment to 

detect synthetic drugs hidden on people, in cargo containers, and 

in other conveyances. Data from substances believed to be or to 

contain fentanyl and found in the mail or in express courier packages is transmitted to CBP’s Laboratories and Scientific Services 

for interpretation. 

At land ports of entry, instruments provide a readout directly to 

officers and agents. The low purities of fentanyl found along the 

southern border, usually only about seven percent of controlled 

substance content, make the detection of fentanyl particularly difficult. 

Canine operations are another invaluable component of CBP’s 

counternarcotic efforts. CBP is currently working to safely and effectively add fentanyl as a trained odor to deployed narcotic detection canine teams. 

CBP has also implemented a program to provide training and 

equipment to keep our front-line employees safe from accidental 

opioid exposure. Through our ongoing pilot program, CBP officers 

are trained to recognize the signs and symptoms of an opioid overdose and administer naloxone, a potentially life-saving drug for the 

treatment of opioid overdoses. 

CBP will continue to do all we can to refine and enhance the effectiveness of our detection and interdiction of fentanyl and other 

dangerous synthetic opioids through the mail and across our Nation’s borders. 

Chairman Portman, Ranking Member Carper, and distinguished 

Members of the Subcommittee, thank you for the opportunity to 

testify today and I look forward to your questions. 

Senator PORTMAN. Thank you, Mr. Perez. Ms. Whitcomb. 
16 

1The prepared statement of Mr. Whitcomb appears in the Appendix on page 101. 

TESTIMONY OF TAMMY L. WHITCOMB,1 ACTING INSPECTOR 

GENERAL, UNITED STATES POSTAL SERVICE 

Ms. WHITCOMB. Good morning, Chairman Portman, Ranking 

Member Carper, and Members of the Subcommittee. Thank you for 

inviting me to discuss our work on inbound international mail. 

First, let me provide some context. We started examining this 

area two years ago after we received complaints that the Postal 

Service was not presenting mail to Customs and Border Protection 

for screening as required. After looking into it, we determined 

audit work was needed. Given our role as the Office of Inspector 

General (OIG) for the Postal Service, we focused on the Postal 

Service’s procedures and its coordination with CBP. We did not review CBP’s operations, although we did talk to their staff to gather 

information. 

Also, both CBP and the Postal Service provided information used 

in our reports. They considered some details sensitive and requested redactions in the public versions of the reports posted on 

our website. 

Inbound international mail primarily enters the postal system at 

five International Service Centers around the country. Generally, 

all inbound international mail is subject to inspection by the CBP 

and the Postal Service must present for inspection all the mail that 

CBP requests. 

The Postal Service received 621 million pieces of inbound international mail in fiscal year 2016. Almost half were packages. The 

growth of e-commerce has caused inbound package volumes to 

nearly double in the last three years, causing challenges for managing this flow of traffic. More than half of the package volume is 

from ePackets, which are small tracked packages under 4.4 pounds. 

Given the growth of international package flows to the Postal 

Service, there is a need to find more effective ways to manage inbound traffic. Some foreign posts send the Postal Service advance 

electronic customs data, which includes information on the sender, 

addressee, and contents of the mail piece. This data helps both 

with processing and inspecting inbound mail. 

International postal regulations are beginning to change in recognition of the importance of posts providing advance electronic 

customs data. The Postal Service can also require this data 

through bilateral agreements it makes with foreign postal operators. However, our audit work found instances of bilateral agreements where the Postal Service had not requested this advance 

customs data. 

Since November 2015, the Postal Service has been piloting a 

joint initiative with CBP in New York. CBP is integrating its data 

systems with the Postal Service’s systems to use advance data to 

target packages for inspection. The Postal Service and CBP intend 

to expand this pilot to new locations before the end of the fiscal 

year. 

We have issued five reports on inbound international mail operations since September 2015 and found several problems with the 

presentation of inbound packages to CBP: 
17 

1The prepared statement of Mr. Schenk appears in the Appendix on page 106. 

First, Postal Service employees sometimes began processing 

packages before arrival scans had been input into the system. This 

could result in pieces missing customs screening or in the acceptance of inappropriate or unknown shipments. 

Second, problems with scanning during processing into and out 

of customs meant that the Postal Service could not always determine whether a package was in CBP’s custody or its own. 

Third, and most significant, at times the Postal Service just did 

not present packages to CBP for inspection when requested. Instead, the packages were processed directly into the mail stream. 

These failures occurred for several reasons including human 

error and electronic system problems. An additional factor is that 

the Postal Service and CBP do not have a formal written agreement regarding the appropriate procedures. 

To address our findings, we have made 11 recommendations in 

areas such as enhancing systems, providing employee training and 

oversight, improving scanning data, ensuring items are presented 

to CBP, requesting advance electronic customs data from foreign 

posts, and coordinating with CBP to establish a formal agreement 

regarding presentation requirements. The Postal Service agreed 

with these recommendations and has taken sufficient action to 

close five of them. Six recommendations are still outstanding—including establishing a formal agreement with CBP. 

Ensuring the safety and security of inbound international mail is 

a critical challenge for the Postal Service and CBP. More effort is 

needed to quickly fix problems in the current process and to make 

sure CBP receives as much electronic customs data as possible. My 

office will continue to monitor this issue, and we will work with our 

colleagues at the Department of Homeland Security Office of Inspector General on any related work that they conduct. 

Thank you. 

Senator PORTMAN. Thank you, Ms. Whitcomb. Mr. Schenk. 

TESTIMONY OF NORM T. SCHENK,1 VICE PRESIDENT, GLOBAL 

CUSTOMS POLICY AND PUBLIC AFFAIRS, UNITED PARCEL 

SERVICE 

Mr. SCHENK. Thank you, Chairman Portman, Ranking Member 

Carper, and distinguished Members of the Committee. I appreciate 

the opportunity to appear before you today to discuss how providing the necessary data to Customs and Border Protection and 

other government agencies can help target contraband and weed 

out bad actors seeking to import dangerous goods and counterfeit 

items into the United States. 

Mr. Chairman, my presence here today, the Thursday before Memorial Day weekend, is quite literally deja-vu. I provided similar 

testimony on this very same day 17 years ago, in the year 2000, 

to the House Subcommittee on Criminal Justice, Drug Policy, and 

Human Resources. The hearing then was titled ‘‘Drugs in the Mail: 

How Can It Be Stopped? ’’ For that hearing, I was asked to do the 

same thing—walk through the processes that UPS follows to supply advanced data to CBP that will enable them to screen for highrisk packages being imported into the United States. 
18 

Unfortunately, since 2000, the problem of importing illicit goods 

into the United States has only grown worse. Enabled by the Internet, bad actors are getting smarter and smarter, using every avenue available to send illicit goods into the United States. Back in 

2000, the issue of illicit drugs in the mail was centered on amphetamines and ecstasy. Today the threat is fentanyl and high-tech 

opioids. The volume of parcels coming into the United States has 

increased substantially, particularly from foreign posts, which now 

send almost 90 percent of packages into this country. 

UPS delivers more than 19 million packages and documents 

every day in over 220 countries and territories around the world. 

We work hard to be United Problem Solvers. Our business processes are complex and our technology advanced. We also work 

closely with CBP, at our own expense, to comply with and even exceed existing legal requirements. The key to making this work is 

the advance electronic data we provide which enables CBP and 47 

other government agencies to target high-risk inbound shipments 

and screen them out of the network, and sometimes that is as 

much as 36 hours in advance. This data can also be used to screen 

for counterfeit products and contraband, another growing problem. 

We also apply technologically advanced network capabilities that 

enable us to locate any suspect package in our system at any given 

time so it can be retrieved and tendered to legal authorities for additional screening. 

In 2000, when I testified before the House Government Oversight 

Committee, there were about 21 million package shipments entering the United States annually—about 10 million through the private sector which were accompanied by advance electronic data, 

and 11 million through the international mail system which did not 

have any electronic data. Even 17 years ago, it was clear that CBP 

and other Federal agencies could not manually screen packages— 

purely because of volume—and that the most effective way of interdicting bad shipments was through the use of advance electronic 

data. 

The volume of packages entering the United States has increased 

many times over. In 2016, foreign posts likely sent over 400 million 

packages to the United States, and the volume is rapidly growing. 

We have been using advance data for years, even before it was required by the Trade Act—Bob and I have worked together for probably over 20 years on some of these things—to provide CBP with 

item-level detail about each and every shipment entering the country. This helps us reduce the potential for dangerous goods entering the United States. It is also important to note that UPS and 

other express carriers obtain and submit data for all foreign countries, both developed and developing, and I could take out my 

smartphone because even in the most remote places, just take a 

picture of it and transfer it on with that. 

In conclusion, if I could take off my UPS hat for 30 seconds. I 

do a lot of international travel and work with customs agencies 

around the world on this very same issue. When I board a flight 

back to the United States, I do not look around at the passengers 

looking for suspected terrorists. I think about the bags and bags of 

foreign post packages that are loaded in the belly of the aircraft. 

No one has any idea what is in those packages, none whatsoever. 
19 

The government does not allow passengers on a plane without personal information or back into our country without a passport or 

a screening. Why do we allow over a million and potentially more 

dangerous packages a day into this country with no requirements 

for information that will allow CBP to do its job more effectively? 

I urge you to take action on this important issue. 

Thank you. 

Senator PORTMAN. Thank you, Mr. Schenk, and I thank all the 

witnesses. 

Senator Carper has generously agreed to delay his questions so 

that we have an opportunity for the two Members who are here to 

ask their questions. I know everybody have other committees to go 

to. I will do the same. 

I would like to start with Senator Lankford. 

OPENING STATEMENT OF SENATOR LANKFORD 

Senator LANKFORD. Thank you, Mr. Chairman and Ranking 

Member. I appreciate that very much. 

Mr. Thome, tell me about where we are as far as moving on advance electronic data and why for developing countries this has 

taken so long when there are some straightforward solutions. If 

they can get the mail to the spot to be able to get it out, why they 

cannot get the data? 

Mr. THOME. Thank you, Senator, for your question. We have 

been working very closely with the UPU to try to move this process 

along more quickly, but the issues that we face in developing countries, I would say previously there was a lack of will and a lack 

of understanding that for them to catch up with their business 

models and take part in the e-commerce boom that is occurring 

worldwide, there was not an understanding that AED was the key 

to that. I think the major advance we have made—and it is not a 

statistic, but it is a change of mind-set within the UPU—is that 

countries now understand, regardless of their level of development, 

they have a lot to earn and a lot to gain and they can even enhance 

their economies by taking part in this global—— 

Senator LANKFORD. All right. So the encouragement from this 

Congress would be at some point to say packages do not come in 

without it. Obviously, that isolates a lot of countries, and it isolates 

a lot of people who may be able to get materials in. But the most 

straightforward way that we could deal with that is just to be able 

to put a clear deadline out there and say we do not allow packages 

to be able to come into our country unless there is some electronic 

data collection of that in advance. 

Mr. THOME. Thank you. Well, as I described in my testimony, the 

global postal system simply is not able to exchange AED comprehensively at this time, and a requirement that it do so immediately as a precondition to our accepting its mail, it would severely 

restrict the inflows of mail into our country and then probably preclude the acceptance of mail not covered by a bilateral agreement. 

And if we stop accepting, cold, other countries’ mail immediately or 

on very short notice, we would have to anticipate that many would 

stop accepting ours as well. 

Senator LANKFORD. Well, I would assume, by the way—I would 

be surprised of anything that Congress could do on short notice. 
20 

However, I would assume that we would set a firm deadline to say 

by this certain date, so that this is not being negotiated in the days 

ahead—this seems to slip year after year. My concern is, how do 

we actually get a certain date that is sitting out there on the horizon that we know this will be resolved? Because this is only one 

element of trying to be able to stop the illicit movement of drugs 

in. Clearly, most individuals that are shipping fentanyl are not 

going to label their package as containing fentanyl. We are very 

aware of that. So this is only one element of being able to help deal 

with this, but this should be a pretty straightforward element. 

Mr. THOME. I agree that it should be straightforward. I think the 

challenge we face is that other countries just are working on other 

timetables. I think we have made good progress, and, again, I 

think that the question of their own needs they now understand. 

Again, the UPU is putting forward half of its cooperation budget 

to helping these countries install the capabilities they need. But 

electricity and the Internet are not available everywhere. 

Senator LANKFORD. Right. But in countries that they are—we are 

still dealing with Germany and France, and the last I heard they 

do have electricity. The United Kingdom does. So we can go on and 

on and on through places that this should be pretty straightforward. So we have to be able to get this resolved. 

Let me ask a separate question. Customs and Border Patrol and 

USPS have worked on a memorandum of understanding (MOU) relationship for quite a while to try to establish consistent methods 

of how they are going to exchange data. How is that working right 

now? And where are we in the process of getting a clear MOU of 

exchanging information? 

Mr. PEREZ. The MOU regarding the general operations, Senator, 

and how that functions at our international mail facilities and how 

that mail is delivered is with CBP. We expect to give that back 

with our comments to the U.S. Postal Service within the next two 

to three weeks. 

Senator LANKFORD. Good. 

Mr. PEREZ. I checked on that just before I got here. 

Senator LANKFORD. I appreciate that. That has been outstanding 

for about a year. 

Mr. PEREZ. Indeed, Senator. The MOU really puts into place best 

practices that have already been in place in a lot of the field locations, including JFK back in New York, on how the mail is handled, that is, the ones that are coming from countries of interest 

for CBP. I am not aware that it specifically gets into the detail of 

the electronic data. That is really more so under the confines of the 

pilot itself that is being run. 

Senator LANKFORD. Do you have a comment on that, Mr. 

Cintron? 

Mr. CINTRON. I just wanted to add to exactly what was said here. 

It has been a year and certainly we have been working at each one 

of our ISCs very closely with Customs and Border Protection to 

make sure that the processes and procedures are in place. We have 

been working through those issues. So it is not like we have been 

waiting for the MOU to get that finalized. So we are certainly 

working. Glad to hear we will have it back in a few weeks and get 

it finalized. 
21 

Senator LANKFORD. Assuming that gets finalized fairly rapidly 

after it comes back in? 

Mr. CINTRON. Yes, you can assume that to be accurate. 

Senator LANKFORD. That would be terrific, obviously. Again, that 

is just basic operation to be able to help increase efficiency in the 

process on this. 

On the Inspector General side of things, tell me where we are as 

far as the things that we can provide the greatest oversight on to 

make sure they get checked off from USPS. I know you gave us a 

very good list of some items that are already being worked through, 

top items for Congressional oversight. What would you list? 

Ms. WHITCOMB. I think the MOU is critical, and I also think encouraging the Postal Service to work on these bilateral agreements 

with these countries to receive the data. I think they are making 

some really good progress. 

When we first started our work in 2015—and Mr. Cintron mentioned it—there was not much data at all available. Significant 

progress is being made and has been made in the last two or three 

years. But it is one of those things that you have to continually 

work on and ensure every bilateral agreement has that requirement in it. So those are two things that I would encourage. 

Senator LANKFORD. I would only say to this group I appreciate 

the diligence and the focus on this. As it has been seen and been 

noted already for commercial entities, this has been something they 

have been very persistent on for a while. Obviously, they have a 

more seamless network. They are not receiving every single package that comes from every single country. They are able to monitor 

that through their system. But it is a system that is achievable in 

the process. 

I would also note for Customs and Border Patrol we appreciate 

very much the work that you are doing. This is incredibly dangerous work. As has already been noted by the Chairman in the 

opening statement, even the smallest amount that gets on an individual as they are doing an inspection is a life-or-death issue. So 

from our Committee to all of your team, we express our gratitude 

for what you are protecting the American citizens from. 

So thank you. I yield back. 

Senator PORTMAN. Thank you. Senator Carper. 

Senator CARPER. Thanks. Thank you so much. 

Sometimes when we have a diverse panel like this but people 

that are highly knowledgeable about a particular issue that we are 

trying to address, I ask them to help us solve the problem. I am 

going to ask you today to help us solve the problem. I am going 

to ask each of you to say: ‘‘If you do not do anything else, do at 

least this,’’ ‘‘you,’’ Congress, this Committee. What is one thing we 

ought to do like right away? 

All right. Mr. Thome, give us one, ‘‘For God’s sakes, do this’’ idea. 

Mr. THOME. Thank you, Senator Carper. 

Senator CARPER. I said earlier this is all hands on deck. I am an 

old Navy guy. It is all hands on deck. We are trying to convey a 

sense of urgency. God knows when we go home, the folks that we 

represent convey a sense of urgency to us, so we are trying to convey that as well. Go ahead. 
22 

Mr. THOME. Thank you very much, Senator. I think as we have 

talked about, this is a difficult problem that needs a lot of solutions, but in terms of the remit of the State Department and our 

interactions with the UPU, as I said before, we have turned the 

corner, and the countries want AED. I think we have to all work 

together to give a realistic timeframe to it. There is urgency to this 

in our country. I am the first to admit that. And as has been discussed, we have an epidemic here that cannot wait years and 

years. 

But with the momentum we have had, I would say, since the 

2012 UPU Congress, it has really accelerated, and countries want 

this. But if they find themselves in a situation where they have a 

Sword of Damocles over their head with a date certain, which is 

why I hesitated to put one on in response to the Senator’s question 

previously, we run the risk of losing that momentum in that if the 

mail shipments are stopped or threatened to stop to the United 

States, that could have devastating effects on their economy. 

Senator CARPER. That is not my question. 

Mr. THOME. Sorry. 

Senator CARPER. I was asking you to give me one takeaway, one 

thing that we ought to be doing to expedite this, to move it. Give 

me one. 

Mr. THOME. I think if we put our efforts behind what the UPU 

is doing and keep that moving, along with the efforts bilaterally 

that are happening, we can make this happen. 

Senator CARPER. All right. And ‘‘we’’ is ‘‘us.’’ Give us some advice. 

All right. Give us some advice. What can we do to get this moving? 

Mr. THOME. I think in my personal opinion the act that you have 

put forward is on the right track, and it will certainly contribute 

to this. We just need to craft it in a way that is realistic to get it 

done with countries that we cannot order to do things, but we need 

to negotiate and help them see the benefit of doing it. 

Senator CARPER. All right. Mr. Cintron? 

Mr. CINTRON. Yes, I guess for us—— 

Senator CARPER. There must be some way we can incentivize 

these folks, particularly some of the nations—and Senator 

Lankford mentioned some of the nations that still are not doing 

their share. And they are not Third World nations. There must be 

some way we can incentivize them. Go ahead, please. 

Mr. CINTRON. I think one thing we would certainly ask support 

around our strategy to target—focus in on targeted countries. We 

understand that that part, when we look at the whole picture for 

us, our strategy has been to really stay focused on where we see 

the largest volume coming in, and I think that is where—we are 

looking for that cooperation certainly, to take that step. As noted 

here, one of the concerns is some of the conditions that we might 

find in some of these other developing countries. But for us, our 

strategy really is going to be to stay very focused and prioritize, 

and we believe through that and through our efforts and what we 

are doing with the AED and the pilot at JFK, we could really push 

this along in order to help Customs and Border—— 

Senator CARPER. You have not answered my question. I asked 

both of you the same question. What does the Congress need to do 

to help move this along, to expedite this? What do we need to do? 
23 

Mr. CINTRON. Well, one other thing, Senator, I might ask is certainly around the passage of comprehensive postal reform for us. 

There are a lot of things that are tied up in that, and anything you 

can do to help us with that regard certainly helps our overall initiatives with everything we are doing. 

Senator CARPER. One of the things—and a number of us have 

been working on this for a while, as you know—is we want to have 

additional postal revenues in order that they can, among other 

things, modernize their mail processing centers. There are 300 that 

need to be modernized. They can buy new equipment, new vehicles 

for delivery. They can modernize the post offices. It sounds like this 

might be another use for some additional revenues at the Postal 

Service, and that might be helpful as well. Good. Thank you. That 

is a good takeaway. 

Mr. Perez, good advice for us. 

Mr. PEREZ. Yes, well, first let me say thank you, Senator, for the 

ongoing support, not just of this Committee but the entirety of the 

Congress, for everything that CBP does and the entirety of the effort that we put forth to combat illegal narcotic trafficking, and 

that is where I would specifically ask ever so respectfully that that 

support continue for all things narcotic trafficking, because CBP, 

frankly, we are not waiting and do not wait for the evolution of the 

different types of threats and the enhancements that we absolutely 

need to lean forward and do everything we possibly can to interdict, to detect, to deter, and dismantle those who would do us harm 

in this fashion. 

And so, whether we are talking about that or whether we are 

talking about tools and technology that we are trying to deploy, 

and even the personnel, that ongoing support that this body continues to provide CBP on the overall drug mission is absolutely 

critical, and we appreciate that. 

Senator CARPER. Thank you. 

Ms. Whitcomb, same question. 

Ms. WHITCOMB. Yes, I think focusing oversight on ensuring that 

the MOU moves forward quickly—and also I just heard a minute 

ago that the MOU does not necessarily cover the pilot program. I 

think that pilot is critical—there are lots of lessons learned 

through that pilot, but expanding that pilot quickly across the 

country to the other International Service Centers so that the data 

that is being received from these countries can be used to target 

specific and dangerous packages. So oversight on that. 

Senator CARPER. OK. If we have a second round, I want to come 

back and talk about the pilot and those lessons learned. 

The last witness, please. Norm? Seventeen years ago today. 

Mr. SCHENK. Pass the STOP Act, and the reason I say that is, 

we discussed it here 17 years ago, and nothing tangible has 

changed, and it is just moving at a snail’s pace. And we think the 

right way is to pass the legislation, and we appreciate all the fine 

work that has been done on that. 

We have worked with CBP for years before the Trade Act, and 

I do not know how they do the job that they do on the mail because 

we have our own challenges with all the data, but we are talking 

about the minimum. So pass the STOP Act. 

Senator CARPER. All right. Thanks so much. 
24 

1The information from Mr. Cintron appears in the Appendix on page 176. 

2The information from Mr. Cintron appears in the Appendix on page 176. 

Thank you, Mr. Chairman. 

Senator PORTMAN. Senator McCaskill. 

OPENING STATEMENT OF SENATOR MCCASKILL 

Senator MCCASKILL. So I understand that—first of all, I thank 

all of you. We are all hands on deck, as Senator Carper said, on 

this, and this Committee is busy doing an investigation into another piece of this, which is the sales and marketing techniques 

that have been employed by the opioid manufacturers. And we are 

also going to be looking at the distributors in terms of that issue 

internally in our country. 

But I want to focus my time here on the fact that we have some 

of this fentanyl produced in China, sent to the United States, 

where then it is sent to Mexico. Are you all aware that this is commonly occurring, that we have a large amount of opioids that are 

moving through our country in that regard? Does anybody disagree 

with that analysis? 

Mr. PEREZ. Senator, if I can comment, I would share that my understanding is that much of the fentanyl coming out of China, 

when in its actual form will come directly into the United States. 

What we have seen that moves from China typically into the labs 

in Mexico that are diluting, creating analogs, and then lacing heroin shipments with the fentanyl as well is precursors, and moving 

directly from China into Mexico. I am not aware, at least at this 

current time, of the movement southbound from the United States 

into Mexico, but I will gladly take that back. 

Senator MCCASKILL. My staff has looked into this and believes 

that there is a significant amount of this that is moving from 

China to the United States, the precursors, and then going from 

the United States to Mexico for them to process in their labs. If we 

are getting wrong information, I can live with that. If you do not 

have the information that is accurate, I am worried because I think 

it is really important that we understand where this is flowing. 

Mr. Cintron, would you agree that you all believe that some of 

this is coming to the United States and then being shipped to Mexico as a precursor to be used in the labs to cut heroin? 

Mr. CINTRON. Yes, Senator, I could not specifically respond to 

that, but certainly the Inspection Service part of the organization, 

we could provide you after this hearing,1 I could provide you information on that. 

Senator MCCASKILL. So I understand that mail from China is not 

covering the costs to the United States Postal Service to handle 

this mail. Is that correct? 

Mr. CINTRON. Again, Senator, I apologize, but I would certainly 

ask your permission to provide any of that information post the 

hearing.2

Senator MCCASKILL. Well, once again, my staff tells me that— 

the United States Postal Service is underwriting the costs of mail 

coming to here from China, and that just seems crazy to me. How 

in the world does that happen? 
25 

1The information from Mr. Cintron appears in the Appendix on page 176. 

Mr. CINTRON. Well, again, unfortunately, I am not able to answer 

that specific question, but I certainly can provide the information 

after the hearing,1 Senator. 

Senator MCCASKILL. Yes, I mean, we are obviously struggling to 

keep the U.S. Postal Service out of bankruptcy. It is one thing to 

be giving Federal Express (FedEx) and UPS a deal on the last mile 

of package delivery, which I have been railing about in this Committee for many years. But if we are actually making it cheaper for 

China to use the United States Postal Service because we are underwriting our costs there, that is really outrageous, and I am anxious to get to the bottom of it. So if you would followup as quickly 

as possible, we would really appreciate it. 

Mr. CINTRON. Absolutely. 

Senator MCCASKILL. OK. So for the Trade Act, it is my understanding in terms of the private deliveries that they are supposed 

to be having the information on the packages they send the name 

and the address of the recipient coming into this country from 

other countries. But I understand that many times all CBP gets is 

the address of the processing facility where it is coming to and not 

the address of who the actual recipient is. Is that accurate, Mr. 

Perez? 

Mr. PEREZ. In the context of the U.S. Postal Service, the general 

mail, that is true. That is the type of data that we are pursuing 

through the pilot to begin to get more of that Senator. 

Senator MCCASKILL. I am talking about Phase 2 of the Trade Act 

requiring the name and address of the recipient from the private 

carriers. Has that been fully implemented? Are we getting the address and recipient not from the Postal Service, but from FedEx 

and the other private carriers? 

Mr. PEREZ. From the express consignment carriers? To my 

knowledge, yes, Senator, but I would take that back to make sure 

we can confirm that for you. But from those other commercial entities and carriers, we typically do get a pretty comprehensive list of 

information in advance with respect to those particular shipments. 

Senator MCCASKILL. Well, once again, my information based on 

staff’s preparation for this and the preparation I have done for this 

hearing is that, in fact, they are not providing the name and address of the recipient and that many times all you get is the address of the UPS or FedEx processing facility where that package 

is coming. I really would like to know why my information is different than yours. 

The other information that I have is that we are not even imposing the fines that need to be imposed on the carriers who are not 

following the law. By the way, this is the Trade Act that was imposed after 9/11, when we were trying to get after the security of 

our ports and the security of the entry ports in terms of our country in terms of goods, people, and services. So I will be anxious to 

hear you follow up about that. 

Phase 3 of trade implementation was supposed to be penalties for 

the bad description, and it is my understanding that Phase 3 has 

not been implemented. Does anybody know the answer to that 

question? 
26 

Mr. PEREZ. I do not have the details on Phase 3 of the Trade Act 

implementation, Senator, at this time. I would gladly take that 

back and get it back to you and your staff. 

Senator MCCASKILL. OK. If we are not getting the address of 

where the package is going and we are not fining the carriers 

ahead of time so we can actually look to see if this was an address 

that has popped up before—I mean, law enforcement needs to be 

all hands on deck here. If we are not getting that and we are not 

even knowledgeable about whether or not we have implemented 

the part of the law where penalties are enacted, our research indicates that sometimes penalties have been imposed, but they have 

been negotiated down by the carrier’s lawyers from thousands of 

dollars to $50. If that is occurring, that is a huge problem. I am 

a little worried that folks do not have the answers to these questions at this hearing, understanding the subject matter of this 

hearing, and I will look forward to getting the answers to them as 

quickly as possible. 

Yes, Mr. Schenk? 

Mr. SCHENK. Senator, if I may respond to that, certainly from a 

UPS perspective, we have been providing that information, full information of the shipper, the consignee, description, value, country 

of origin, since we started bringing international imports into the 

United States in 1985, and the program was developed with CBP. 

I would also say that we have gone well beyond the Trade Act, 

working with CBP with the Air Cargo Advance Screening process, 

which is a voluntary program that was implemented after the 

Yemen bomb attempt on that, where we not only transmit the shipper and the consignee, we go the extra mile and transmit the multiple consignees when it is e-commerce shipments. 

So speaking for UPS, we do not only the required, but we go beyond the required. 

Senator MCCASKILL. So in your opinion, has Phase 3 been implemented? Do you believe there are penalties that would apply to you 

if somehow a package came to the United States through your company that did not have the address of the recipient on it? 

Mr. SCHENK. The answer to that one is I do not know how we 

could, because our processes and systems are developed a package 

cannot enter our system unless that information has been entered 

in there, and then it cannot move through—because our systems 

interconnect between UPS and CBP. Practically speaking, it could 

not happen. 

Senator MCCASKILL. OK. Well, we will follow up on the information we have and get information from all of you and go forward 

from there. Thank you very much. 

Senator PORTMAN. Thank you, Senator McCaskill. 

I am going to ask my questions now, and we will have another 

round as well. I know Senator Hassan has agreed to stick around, 

and I appreciate that. And we have another colleague who has 

joined us. 

First of all, I think we need to back up and talk about what this 

hearing is all about, and, Mr. Perez, I expect your answer on this, 

and all of you. Is it helpful to have advance electronic data to be 

able to identify these packages that have this poison in them, 

which is what we are focused on today, which is synthetic opiates 
27 

that are coming into our country, killing more and more of our citizens every day? Do you want to have that advance electronic data? 

And is that helpful for you to be able to stop some of this poison 

from coming into our communities? Yes or no. 

Mr. PEREZ. Unquestionably, Mr. Chairman, having the advance 

electronic data, as we do receive for all of the types of cargos, is 

a key tool in our ability to manage and assess risk, to focus and 

target those threats that may warrant a greater inspection, potential threats that may warrant greater inspection cargos, people, 

conveyances of all types. And so, unquestionably, having that data 

and working toward or getting that advance data and making sure 

that it is of high quality and reliable for us to do that work is a 

high priority and the reason why we are working so closely with 

our colleagues to get to that point. 

Senator PORTMAN. Otherwise, it is like the needle in the haystack I talked about earlier, and, I meet with your folks back home, 

and they use the exact word you just used, ‘‘This is a tool we desperately need.’’ Otherwise, we are just not effective at stopping this 

stuff. And it is other contraband as well, but we are focused here 

on a crisis. I appreciate the State Department perspective on diplomacy and trying to work with other countries, and I really appreciate you, Mr. Thome, saying that you think the STOP Act is on 

the right track. But the notion that other countries are working on 

their own timetables and some countries do not have electricity, 

China has electricity, and we know where this stuff is coming from. 

Some of it is coming from India as well. They have electricity, too. 

Mr. Cintron, I understand your concern about having to apply this 

to all countries, and you noted in your comments you prefer it to 

be targeted to countries that are known to be sending us this poison. Let me just follow up on that a little bit. Senator Carper and 

I talked about this yesterday. We are working also on this issue of 

countries that circumvent our trade laws because they have a tariff 

attached to them, because of a dumping order, let us say, and they 

just simply ship the product to another country. Why would that 

not happen here? If you said we are only going to target, a couple 

countries where we know they are countries of interest, why would 

they not just ship it through another country, say Vietnam, Malaysia, or Indonesia, and still have these poisons come into our country? Can you answer that question? 

Mr. CINTRON. What I would say is this: Our focus, our strategy, 

as I spoke, is to prioritize the list, right? So take a look at it, make 

a risk assessment, and target those particular countries. Certainly 

the Inspection Service working in collaboration with the other law 

enforcement agencies I think is probably the other key, right? So 

as you collaborate, we share information, if those events occur, I 

think then we refocus and do that. 

I guess our point is there is a starting point, and our piece was 

around where is the highest risk, where do we see the highest volume, and how do we go to your point on capacities? Those particular countries that have it, we should really be focused on those 

and get that information. 

Senator PORTMAN. No question it is a crisis and we want you to 

prioritize, but, unfortunately, what we have seen is there is transshipment of this stuff, and it is going to simply be shipped to other 
28 

countries from the evidence that we have. You noted earlier that 

it is voluntary now. I would ask you, do you have enough data? 

Your answer is going to be no, because you would like more advance electronic data from these other foreign posts. 

So, again, what our legislation says is, it is time to follow up on 

what Congress passed 15 years ago, which was asking the thenCabinet Secretary in charge, now Homeland Security and the Postal Service and the Commissioner to come up with a plan. Norm 

said he testified 20 years ago, even before that, I assume that was 

in the context of preparing for the 2002 Trade Act. 

So I would just make the point broadly that we do have a crisis. 

We have all acknowledged that. This is not business as usual, and 

if other countries are working on their own timetable, that does not 

work. That dog does not hunt because it is an epidemic. You noted, 

Mr. Thome, which I thought was interesting, that advance electronic data is in their interest, too, and there is a consensus now, 

you said, among countries around the world that they need to provide it. Well, let us get moving on it. 

Another question I would have is for you, Mr. Perez. You talked 

about canines. I just have to ask you this question, because I asked 

this same question of one of your colleagues at a roundtable discussion at this very spot about a year ago, and I was told that sniffing 

dogs do not work because the dogs could die from sniffing a package or a letter with fentanyl in it. What is the situation with regard to monitoring generally and screening? Many of us support 

legislation to provide more funding for more inspection. But specifically with regard to canines, does that work or is it too dangerous? 

Mr. PEREZ. Thank you, Mr. Chairman. On the canine front, we 

are currently in a test phase to train the canines for the specific 

odor. As you probably know, they are trained for a variety of narcotic odors, and so depending on the actual form and nature of the 

narcotic, they may detect and/or be able to alert to some of the 

opioids. But we are specifically training them in a very safe way 

with the types of odors that are generally emitted from fentanyl 

and such, not with actual fentanyl but with our Laboratory and 

Scientific Services folks to make sure that we are doing so in a safe 

way. Nevertheless, we are enabling that tool, along with the other 

technical and/or electronic tools that are at our disposal, and are 

actually taking readings from the suspect packages and sending 

the spectra back to our labs to determine whether or not there is 

a presence of fentanyl and other opioids. 

Senator PORTMAN. I would like to think it could be done safely. 

The dogs do not have the masks we talked about earlier, and 

gloves that they can put on, so I would suspect it is still a huge 

danger to them. Much better to have targeted packages where you 

have reason to suspect a package by having this advance electronic 

data. I assume you would agree with that. 

Mr. PEREZ. Absolutely, Mr. Chairman. 

Senator PORTMAN. Ms. Whitcomb, you talked about the pilot program, about the lack of coordination between the Postal Service 

and CBP and the need for a memorandum of understanding 

(MOU), and a written agreement you said is necessary. You said 

you had 11 recommendations, six of which are still outstanding. 

You said we ought to expand this pilot quickly. Have you looked 
29 

at our legislation? Do you think our legislation, the STOP Act, 

would help to expand that pilot quickly? 

Ms. WHITCOMB. We did look at the legislation. We did not do a 

detailed analysis of the impact of the legislation on the Postal Service. We are supportive of the general idea in the legislation about 

increasing the amounts of advance electronic data. However, the 

impact of that on the Postal Service is something that we have not 

done a detailed analysis of. We do believe, as we said in our statement, that additional data would be really helpful, and I think the 

pilot is moving in that direction as well. 

Senator PORTMAN. Well, that is what the STOP Act is about, is 

making that mandatory and moving away from just making it a 

pilot, but making it a requirement. 

Mr. Schenk, just quickly for you, and then I will turn to my colleagues. You talked about testifying in 2000 on this, 17 years ago, 

and the fact that you get your data to CBP sometimes 36 hours in 

advance. Thirty-six hours in advance gives them time to be able to 

respond to it. 

Tell us how you do that. How do you do what the Post Office has 

not been able to do over the last 15 years since the Trade Act. 

Mr. SCHENK. Thank you, Chairman. It really starts with the collection of the data, and it depends on the size of the customer, but 

the bottom line is for the large multinationals we have software 

and direct interfaces with them. But even in the individuals that 

walk into one of our UPS stores, it can be input. So we get the information into the system immediately. 

As soon as the package is picked up, that is what actually is the 

indicator, and every 15 minutes our system automatically transmits to CBP so that we can get the information to them as early 

as possible. That was part of the collaborative effort that I think 

from the business side we have a shared responsibility to do that. 

Then depending on what is going on with the shipments, they communicate back with what is going on, but the principle and foundation of what we do for CBP is let us get the data and let us get 

it to you as soon as possible so that you can begin that. 

Now, there is a couple of transmissions—it gets a little technical, 

but it is very, I think, good—— 

Senator PORTMAN. When the package is picked up, the data goes 

and the law enforcement folks of 47 agencies we talked about have 

access to it. Senator Hassan. 

Mr. CINTRON. Chairman, can I clarify? 

Senator PORTMAN. Yes. I want to get to Senator Hassan. She has 

been very patient. If you do not mind, we will do a second round, 

and I will have the opportunity to speak with you as much as you 

would like. Senator Hassan. 

OPENING STATEMENT OF SENATOR HASSAN 

Senator HASSAN. Thank you, Senator Portman and Ranking 

Member Carper, for allowing me to participate in this Subcommittee and for your leadership on the STOP Act. 

I do want to just take a minute also to echo Senator Carper’s reminder that while we are focused today on the supply of illicit 

drugs and especially the precursors to these synthetics like 

fentanyl and carfentanil, we have to continue to also focus on the 
30 

demand side here at home, which is why Medicaid expansion and 

continuing work to make sure people can get treatment—and we 

are working on prevention as well—is so important. 

As you all probably know, New Hampshire is one of the States 

that has been hit hardest by the opioid epidemic. Last year, 70 percent of our overdose deaths involved fentanyl; 80 percent so far this 

year involved fentanyl. We are seeing acetyl fentanyl, so an analog 

of fentanyl, and just in the last six weeks or so, we have seen now 

six deaths for carfentanil. So to echo what my colleagues are saying, everywhere we go we are talking to people from all walks of 

life whose lives have been taken or ruined or impacted, and it is 

a drain on not only our lives and our communities, but our economy as well. 

I wanted to focus just a minute, because in my last briefing with 

the DEA at home, they recounted to me in very graphic and vivid 

details how dangerous fentanyl and carfentanil is for our law enforcement and first responder personnel, and that obviously extends to people who may be handling these substances through the 

postal system. 

We know you can overdose by touching this stuff with a bare finger or breathing it in. Carfentanil in particular is changing the way 

our law enforcement is dealing with everything about the way they 

enter a suspect’s home to a crime scene afterwards. 

We also know we do not want to put third parties like USPS personnel at risk, so let me just start, Mr. Cintron, with you. What 

has the Postal Service done to help address these risks to USPS 

employees? And can we both protect our workers but make sure 

that law enforcement has the tools that they need to investigate 

and crack down on the supply of these synthetics? 

Mr. CINTRON. Yes, Senator. The USPS has over 600,000 employees, so from processing to delivering the mail, transporting the 

mail, all of our employees are involved in that supply chain of 

doing so. And on a regular basis, whether it is at International 

Service Centers or other processing centers around the country, delivery operations, we do a lot of training with our folks around hazardous-type conditions. We have seen tragedy in the past in this 

organization, so we are very well aware of effects of what that can 

do. 

Our focus really is to constantly and consistently train employees, and we do the same with our Inspection Service, which does 

a lot with our processing facilities as well for oversight and investigating and addressing issues that we find in the mail. 

Senator HASSAN. Thank you, and I will ask Mr. Perez to comment. You discussed steps CBP has taken to protect its personnel, 

and I would love it if you could expand and again talk about the 

balance here. I know of an agent in New Hampshire who was doing 

everything right. She was all masked and gloved, and then she 

took off a glove to handle the suspect’s cell phone, and she OD’s, 

brought back by multiple doses of Narcan. So I was very concerned 

about it. 

Mr. PEREZ. Well, thank goodness, Senator, and thank you. Beginning in 2015, in fact, we began a very comprehensive training and 

instruction that was deployed to all our front-line officers and 

agents, the people who would typically potentially come in contact 
31 

with these substances that went into great depth on the proper 

handling, the personal protective equipment (PPE) that they need 

to don and wear if and when they encounter a parcel of any type, 

or a person for that matter, that may be carrying—a vehicle as 

well, where they believe the presence of these dangerous opioids 

may be. 

So in addition to that, we began our naloxone program as well 

so that we have those countermeasures deployed in over 34 locations now over the past two years. Those locations include all the 

busiest express consignment facilities, all the busiest international 

mail facilities, and the locations along the southwest border where 

we see the most trafficking in these types of opioids. 

The last point I will make in addition to all that is that we have 

also deployed over 600 doses of Narcan in addition to the naloxone 

throughout the country. As a side note, the officers and agents that 

are typically trained in actually utilizing these are EMS-certified 

CBP officers and/or agents. So that is pretty much what we are 

doing, and we continue to make sure that that training, that 

awareness is ongoing, and that we do absolutely everything we can, 

particularly with the uptick in our encounters with these drugs. 

Senator HASSAN. OK. And, Mr. Schenk, I am going to ask you 

to answer the same thing. Obviously, the concern here is if, for instance, law enforcement thinks that they are putting third parties 

at risk through certain kinds of undercover operations, then they 

are going to stop doing it. We obviously need to be able to continue 

investigations. So it is helpful to hear that training is ongoing. But 

how does UPS address this issue? 

Mr. SCHENK. I will be honest with you, I really do not know the 

answer, but I will get back to you on that. 

Senator HASSAN. There used to be certain kinds of undercover 

operations that, I think law enforcement is taking a look at because of the risk to people handling a package that they may not 

know has an illicit and deadly substance. So it would be great if 

you would look at it. 

Mr. SCHENK. I will get back to you. 

Senator HASSAN. The one other thing I wanted to ask Mr. 

Thome, you discussed in your testimony that fentanyl and other 

synthetics are bought online, bought both on the open web and the 

dark web. So what efforts are being made internationally to crack 

down on illegal purchases of these synthetic drugs and the precursor chemicals that are used in them? I know a lot of what we 

are doing here, but what is happening internationally? 

Mr. THOME. The State Department is engaged in extensive negotiations with countries that we feel are sources for these kind of 

things. I cannot give you a comprehensive answer across the board, 

but I did talk with our Bureau of Narcotics and Law Enforcement, 

and they did give me some information on what has happened with 

China, which is of great concern and has been brought up, so I 

could share that with you. 

So in response to repeated U.S. requests made through the bilateral joint liaison group that we have with China on law enforcement, China has, in fact, domestically controlled now more than 

134 synthetic drugs, including carfentanil. So this is an advance 

that we have made in getting them to see this. 
32 

China’s decision to domestically control, for example, carfentanil, 

which has caused the deaths in the United States that you mentioned, is a welcome measure, and we hope we can continue working with the Chinese. In many cases, the Chinese argue to us that 

these are not causing problems in their country, and we have succeeded in convincing them that even if that may be something they 

claim, they are causing problems in our country, and we want them 

to take measures. 

So, again, we continue that process. There is a lot of work left 

to do, but we have had that success. 

Senator HASSAN. Thank you very much, and thank you, Mr. 

Chairman. 

Senator PORTMAN. Thank you. Senator Tester. 

OPENING STATEMENT OF SENATOR TESTER 

Senator TESTER. Thank you, Mr. Chairman. 

So for you, Mr. Schenk, the packages are dropped off at a UPS 

facility, whether it is here or in some other foreign country. You 

are able to track those with a code, to electronically track them, 

share information with the Customs and Border Protection, and 

that is pretty much your system, correct? 

Mr. SCHENK. That is correct. 

Senator TESTER. OK. And the Postal Service, tell me why you 

cannot do the same thing. 

Mr. CINTRON. For inbound packages coming in, foreign shippers 

ship to a foreign post, and then they tender into the USPS, so we 

do not have that direct connection at a point of origin. 

Senator TESTER. OK. So, State Department, why we cannot require that from the shippers in foreign countries, their equivalent 

of their post office? 

Mr. THOME. Well, as my colleague from the Postal Service says, 

unlike the express shippers that control both ends of the transaction, we do not control both ends. 

Senator TESTER. But why we cannot tell them that they cannot 

utilize our post office unless they have an electronic tracking number on it that we can track and share with CBP to cut down on 

this baloney? 

Mr. THOME. Our treaty obligations at the UPU, which is an organization based on reciprocity for the exchange of international 

mail—— 

Senator TESTER. Right. Would we do that for them, by the way? 

Would we give them an electronic tracking if they requested? 

Mr. THOME. We have offered, and we certainly would like to be 

able to share data with them if they have the capacity to use it. 

We would. 

Senator TESTER. So here is the problem. The Ranking Member 

and the Chairman talked about the fact that we have a problem 

in this country. And we have a problem in this country. So I get 

it, they do not want to do it. I do not want to do a lot of things 

that I am told to do. So why we do not hold their feet to the fire? 

I mean, the truth is, would it have some impacts on our country? 

Yes, it would probably have some economic impacts. But I am here 

to tell you not doing is having economic impacts. 
33 

And so, is there any way people could roll up their sleeves and 

say, hey, look, we have people dying every day in every State in 

the Union from this crap, and it is time to say, ‘‘Enough’’? 

Mr. THOME. Mr. Senator, I would definitely argue that we are 

doing our level best to hold their feet to the fire and to demonstrate 

to them—— 

Senator TESTER. Has the threat been made that you are not 

going to be able to ship it via the Postal Service if you do not do 

this? 

Mr. THOME. We have not made that explicit threat. That, again, 

would be outside of our treaty obligations. 

Senator TESTER. It is actually not a threat. It is a real-life situation. I mean, look, we can pat people on the back and say, ‘‘Please,’’ 

but that has not worked. So, I am not in the negotiation, so I do 

not know what you guys are faced with. But I do know what we 

are faced with in this country, and this is costing a pile of money 

and ruining a lot of lives. I would just encourage you the next time 

the UPU meets to buckle down and do it. Otherwise, we might 

have to do something pretty draconian at this end, and I am not 

sure that we want to go that direction. OK? 

Mr. THOME. I take your message, Senator, and I want to assure 

you that we are working very hard to demonstrate the urgency on 

this. 

Senator TESTER. Thank you. And I appreciate that. And it is not 

you, by the way. It is just the general overall thing. I appreciate 

you all being here, by the way. 

The Inspector General, that might be you, Ms. Whitcomb, came 

up with some audit reports on inbound international mail to the 

Postal Service, and this question is for you, Mr. Cintron or Mr. 

Perez, or both. There were 11 recommendations. Five of those have 

been closed. If my math is correct, six are still open. One of the recommendations was that the Postal Service establish an MOU with 

the CBP to better clarify inspection requirements on packages and 

sit down to establish that process. Why are we not doing this? 

Mr. CINTRON. Yes, earlier today we did speak; my colleague Mr. 

Perez indicated that within the next three weeks we will have the 

MOU that is sitting up right now with Customs and Border Protection. It will be tendered back to the Postal Service. Collectively in 

collaboration, we will then get that hammered out and get it in 

place as soon as possible. 

Senator TESTER. OK. 

Mr. CINTRON. Just to reiterate for the record, we have not waited 

for the MOU. A lot of these things we work collectively or collaboratively with customs locally to get these things in place. 

Senator TESTER. Good. Appreciate that. 

Mr. CINTRON. It is going to happen. 

Senator TESTER. Do you agree with that assessment, Mr. Perez? 

Mr. PEREZ. In fact, Senator, yes. I mentioned earlier the timeline 

of getting that delivered and that it is in effect codifying, if you 

will, many of the best practices and procedures that are already in 

place in the international mail facilities around the country. 

Senator TESTER. So if I might, Mr. Chairman, when you get that 

MOU signed three weeks from now, would you rifle a copy off to 

the leadership of this Committee so we know it is done? 
34 

Mr. CINTRON. We can provide it. 

Senator TESTER. OK. Thank you. 

One more thing, and this goes to Mr. Cintron, Mr. Perez, or Ms. 

Whitcomb, whoever would like to respond, if not all of you. And, 

that is, is there legislation that is required in order for you to take 

swifter or stricter actions to prevent these poisons from coming into 

this country? Or do you think you have the ability to do it with 

what is on the books now? Anybody can go. Mr. Cintron. 

Mr. CINTRON. Yes, could you repeat one more time, Senator? 

Senator TESTER. The question is: Do you require further legislation to be able to take swifter and stricter action to prevent these 

poisons from coming into the country? Or do you have enough latitude with the rules that are on the books now? 

Mr. CINTRON. Yes, I—— 

Senator TESTER. Is there legislation that is needed for you to be 

able to stop these drugs from coming in? That is the question. Or 

do you have the latitude to do it today? 

Mr. CINTRON. I would defer to the State Department, maybe, or 

Customs to maybe answer. 

Senator TESTER. Mr. Perez. 

Mr. PEREZ. Yes, Senator, we are very comfortable with our authorities. 

Senator TESTER. Good. 

Mr. PEREZ. Nevertheless, again, I just would continue to emphasize the unquestionable need to further the efforts to get the advance information. 

Senator TESTER. All right. Ms. Whitcomb, do you have anything 

you would like to add? 

Ms. WHITCOMB. I would just piggyback on what Mr. Perez said, 

that the timing of rolling out this pilot I think is critical to this legislation does not go into—— 

Senator TESTER. I would just ask that if you have any recommendations that need to be changed within the code, do not be 

afraid to tell us. That would be helpful. All right? 

Thank you all for being here today. I very much appreciate it. 

Senator PORTMAN. Thank you, Senator Tester. Senator Daines. 

OPENING STATEMENT OF SENATOR DAINES 

Senator DAINES. Thank you, Mr. Chairman. 

Mr. Chairman, I want to thank you for your personal leadership 

on this issue. The people of Ohio and the people of this country 

would have been very proud, what I saw six weeks ago. I was with 

the Chairman in Beijing. We had meetings with the chairman in 

China, the Chairman of the NPC, Zhang Dejiang, number three in 

charge of all of China, followed by a meeting with the premier, Li 

Keqiang. Mr. Chairman, you were very direct in asking for help 

from the Chinese Government at the very highest levels to deal 

with issue of the source of fentanyl and carfentanil, and thank you. 

I saw that behind closed doors, and thank you for your leadership 

that extends and influences beyond this country and around the 

world to stop this scourge. 

Senator PORTMAN. Thank you, Senator. 

Senator DAINES. Thank you for testifying today before our Committee. In recent years, in my home State of Montana, we have 
35 

been facing a meth epidemic. I realize it is something that started 

with the opioids and meth in the Northeast, working its way across 

the country. It is in Big Sky country as we speak. 

Largely, the import of meth is coming from Mexico. It has 

gripped my State, and it has shown the somber and sad signs of 

the drug’s widespread presence. In fact, in December 2016, the 

Montana Department of Justice (DOJ) issued a report that there 

were 14 children that died in our foster care system; 11 of those 

14 children died as a result of household drug use, and four of 

those were specifically linked to meth. That is not the way you are 

supposed to grow up with a child in our great State. 

In addition, the Montana Department of Justice Division of 

Criminal Investigation has seen since 2010 to 2015 a tripling of the 

number of cases they are addressing as it relates to meth. Meth 

has left its mark on Montana through increased incarcerations, increased death, heartbreak, and in straining our community resources to keep up. To stop the importation of meth at its source 

would go far to begin the healing process in States like Montana. 

Mr. Cintron, in your written testimony, you mention that from 

fiscal year 2015 to the present, the use of advance electronic data 

for inbound international mail increased from approximately one 

percent to somewhere in the 40-to 50-percent range. And I know 

in Montana, Mexico has specifically been identified as an overwhelming source of meth. 

My question is: What countries have been either collaborative or 

particularly unresponsive in sharing advance electronic data? And 

the second part of that, has Mexico been at all helpful in providing 

the necessary data? 

Mr. CINTRON. Yes, I could provide that information after the 

hearing. We have many countries that we have agreements with, 

like, I called out before that we have bilaterals with many other 

countries that we are receiving advance electronic data from that 

make up that 40 to 50 percent. But I can certainly provide you 

some better information after the hearing specific to Mexico. 

Senator DAINES. And any zeroing in on a couple of specific countries, as you mentioned, Mexico and China are the largest sources 

of illicit drugs. Have they been responsive in working toward the 

Universal Postal Union’s 2020 implementation date for universally 

providing advance customs data or are we just grasping at the air 

on this one? 

Mr. CINTRON. As it relates to China, certainly, again—and I can 

provide better data—absolutely we are seeing substantial data that 

comes back, the advance electronic data from them, and I can certainly provide you that information after the hearing. 

Senator DAINES. OK. Thank you. I would appreciate that. 

Mr. Schenk, you mentioned in your testimony that the UPS delivers more than 19 million packages and documents each day 

while providing the advance customs data. Could you share, Mr. 

Schenk, one, how many packages containing illicit drugs are removed from delivery by CBP due to the use of advance customs 

data? And, number two, what percentage might those packages 

represent? 

Mr. SCHENK. Thank you, Senator. For that, the reality is we are 

not perfect. We would like to say that no bad people are going to 
36 

use our network, but they certainly attempt to do that. Fortunately, with the relationship that we have with Customs and Border Protection and sharing information, we do find ways to interdict it, and we do get some occasional shipments. We have had several shipments of fentanyl over the past year that were seized by 

CBP, and then we also had actually a little bit more in terms of 

numbers of shipments of meth that was mentioned earlier that got 

seized with that, and we work with CBP. 

In terms of percentage of it, it is minuscule. One of the reasons 

that we would hope that the bad people do not try and use our network is because of all the programs that we do, and actually what 

we are talking about here is kind of 101 border level stuff with 

that, plus our ability to track and trace and then work with the 

local authorities, which we do on investigations. 

Senator DAINES. Mr. Cintron, do you have an idea of the estimate of the percentage of packages under current practices that 

are flagged because of illicit drugs? 

Mr. CINTRON. I would have to defer maybe to Mr. Perez to answer. 

I can provide you the data after the session. It is a very small 

percentage, but we can certainly provide that information after the 

hearing. 

Senator DAINES. And small is, I guess, less than one percent? 

Less than five percent? Any sense of how small is small? 

Mr. CINTRON. Do not have that exact. 

Senator DAINES. OK. 

Mr. CINTRON. But I will provide that. 

Senator DAINES. OK. Thank you. 

Let me just close by saying I do believe the most effective way 

to end the meth crisis in a State like Montana and allow this healing process to begin is going to be by cutting off meth at its source. 

Yes, we have to work on our demand issues, but we can work together here on source. We will need the collaboration between the 

USPS, CBP, and our foreign post stakeholders. And if our foreign 

post stakeholders decide not to cooperate, I do think we need to 

take stronger action and do put America first in this equation. 

Thank you, Mr. Chairman. 

Senator PORTMAN. Thank you, Mr. Daines. Senator Heitkamp. 

OPENING STATEMENT OF SENATOR HEITKAMP 

Senator HEITKAMP. Thank you so much, Mr. Chairman, for taking on this issue. It is critically important. I remember a conversation we had last Congress. DEA was in the room, and when I suggested that they may want to use drug dogs to detect fentanyl 

packages, the DEA agent told me that would not be wise given that 

if they actually could smell it, they would die. The dogs would die. 

So we are dealing with an incredibly dangerous material. And this 

is moving through the Postal Service, and every postal worker who 

touches a package is at risk. 

And so, for the Postal Service, it is not just about processing and 

getting things through, but it really is an issue of care for your employees. So I just wanted to raise that. 

Ms. Whitcomb, we noted in your testimony that the Postal Service OIG report, your audit work, found that the Postal Service had 
37 

the ability to request advance custom data under several bilateral 

agreements, but opted not to do that in certain circumstances. Why 

did the Postal Service make that determination? What would you 

recommend in response? 

Ms. WHITCOMB. Yes, I think most of the bilaterals that did not 

have these requirements in them were older bilateral agreements. 

More recently, the negotiations on bilaterals have included this requirement, so I believe it is more of a timing issue and recognizing 

the importance of this. I think it has improved over time, I should 

say. But some of the ones that we had reviewed that did not have 

this requirement were older bilateral agreements. 

And Mr. Cintron may know a little bit more about the direction 

the Postal Service is taking to include this more consistently in the 

bilateral agreements than I do at this point. 

Senator HEITKAMP. Mr. Cintron. 

Mr. CINTRON. Yes, Senator, all new bilateral agreements require 

advance electronic data. 

Senator HEITKAMP. OK. And this is for anyone on the panel. It 

appears that one of the arguments being made regarding the Postal 

Service being unable to utilize a system similar to the system that 

has been outlined by private shippers and carriers is a cost issue. 

I understand that other issues also complicate equalizing the shipping requirements, but cost, processes, and technology seem to be 

a factor in the Postal Service claims which are inhibiting their efforts. Is this an accurate statement? If so, how do we bring down 

the cost of compliance and technology? Is it possible to look at 

prioritizing the advance electronic data upgrades through a tiered 

system with foreign shippers? And under the current method you 

are using to try and address this situation, how long do you think 

it would take to get foreign countries utilizing AED at higher 

rates? Do you have any plans to have that discussion? I guess 

maybe we could start with you, Mr. Perez. 

Mr. PEREZ. Through the pilot program that we have, Senator, 

with the U.S. Postal Service, we are currently getting advance electronic data from several different countries. Specifically, the pilot 

in JFK has to do with both China and France, and so we are going 

to continue to focus on that and work alongside our Postal Service 

partners to see what else we can do to make sure that we are being 

able to not only utilize and get that advance electronic data, but 

then focus our efforts to expand not only the volume that we are 

able to apply, but, again, the quality itself so that we can make 

better and more informed decisions on where it is we need to focus 

our efforts. 

Senator HEITKAMP. Mr. Cintron? 

Mr. CINTRON. Yes, I certainly wanted to—and I can clarify more 

on the point earlier, is that for us with the AED and the pilot in 

JFK, certainly one of the things that we are going to be looking to 

do, expand that part of it to the other ISCs that we have, and certainly get better with the amount that we are generating that is 

going to—and I can speak more about that later. 

In regard to the costs, the cost really are going to be incurred at 

the foreign post where, they really have the technological upgrades 

and challenges that will really need to be—that is where those 

costs are going to come in, and certainly that is the difference, I 
38 

think. The technology part of what we can do on our side is a little 

bit different in regard to AED once we actually get the data itself. 

Senator HEITKAMP. I do not want to prolong this, but I will tell 

you, if we were happy with the speed to which the U.S. Postal 

Service were dealing with this issue, you all would not be here. 

This is not moving fast enough. We see these drugs coming in. We 

have had numerous deaths in my State because of fentanyl abuse. 

And we know that the delivery point is the United States Postal 

Service, either point to point in this country—my recent investigation and prosecution regarding fentanyl moving in the mail from 

Portland, Oregon, but it originally came in from Canada. This is serious stuff, and it needs to be addressed. And we need to have a 

plan, it seems to me, with detailed timelines. And if resources are 

a problem, we need to know that. If there is a legal problem with 

the bilaterals or with the agreements, we need to know that. If 

there is a resource problem, we need to know that. But we have 

to stop jeopardizing the lives of people who move this stuff, whether it is at the post office or people who come in contact with a package unwittingly. But we have to have a plan, and it is frustrating 

because we addressed this in a roundtable last year or the year before, and I am hearing the same things over and over again. And 

pilots are good, but they do not give us a plan. 

And so, I applaud the Chairman and the Ranking Member for 

bringing this issue to the Committee. This is something we are 

going to be serious about in terms of oversight and moving forward. 

So with that, Mr. Chairman, I will yield back the rest of my 

time. 

Senator PORTMAN. Thank you, Senator Heitkamp. 

We are now going to do a very quick second round, a lightning 

round, and let me just say I agree with what my colleagues were 

saying that we are not moving fast enough. Let me give you a specific example of this. 

There was a letter sent in April 2016, more than year ago, to this 

Committee. In that letter it said, and I quote, ‘‘The plan to expand 

the John F. Kennedy (JFK) pilot program with China to Los Angeles International Airport is currently scheduled for the summer of 

2016.’’ We are now in the summer of 2017. Has it expanded? 

Mr. CINTRON. It has not expanded beyond—— 

Senator PORTMAN. No. OK, it has not. The UPU, we have heard 

today about what is going to happen with regard to the Universal 

Postal Union, and with all due respect to our international partners and the UPU, will it get done by 2018, 2020, or even 2022? 

They keep pushing it back with respect to advance electronic data. 

So, look, if we did not have a crisis in this country, we could kind 

of go along with the normal routine, which is, as was said earlier, 

and I quote, ‘‘other countries are working on their own timetables.’’ 

We cannot afford to have them work on their own timetables because our people are dying. I guess the question I would ask this 

morning is: How many more Americans have to die before our government gets its act together and makes sure that the pilot is 

working, makes sure that it is expanding as it was promised, which 

has not occurred, and makes sure that we are actually doing everything we can to keep this poison out of our communities? 
39 

Admittedly, this is not the silver bullet. There is not one silver 

bullet. I am going to steal a line from my Ranking Member, who 

said there is a lot of silver BBs, but this is one of them. Every one 

of you have acknowledged that today. 

My hope is that because of this hearing we will be able to move 

more quickly on this issue, we can get this legislation passed to 

give you the additional authority I think you need to have. As Mr. 

Perez said, rightly, you need the tools to be able to identify the 

right packages, to go after them, to stop some of this poison, and 

also to increase the cost on the street, because right now this stuff 

is so cheap and so deadly that it is killing more and more people. 

We are going to hear from the next panel about what is happening in our communities and what is likely to happen this year 

as compared to last year. The summary is more people dying, getting worse and worse. 

So thank you all very much for being here, and I now turn to 

my Ranking Member, Mr. Carper. 

Senator CARPER. Thank you. Thank you, Mr. Chairman. 

When Senator Heitkamp was speaking just a moment ago, I am 

reminded of the work that we have done, a lot of on this panel have 

done on postal reform legislation over the years. And one of the 

things we focused on is how do we increase the revenue flow to the 

Postal Service so that they can replace vehicles that are 25 years 

old, a 25-year-old fleet, so they can modernize mail processing centers, which really are not designed to handle large packages or parcels. And, number three, how do we modernize post offices, provide 

better service from post offices, and with rural letter carriers that 

are sort of mobile post offices? How do we provide those revenues? 

There is another reason why the Postal Service needs revenue, 

and it is to be able to do their job, a better job with respect to intercepting and stopping the movement of these highly toxic chemicals. 

And we are going to use that. We are going to use that in reminding our colleagues why it is important to move on postal legislation 

and sooner rather than later. That is one of the reasons why we 

need to do that. 

The other thing I want to come back to is the pilot. Take me to 

the pilot, if you will. It is JFK, right? 

Mr. CINTRON. Yes. 

Senator CARPER. And, again, why the delay in spreading and extending the pilot to the other four destinations? Why? 

Mr. CINTRON. Yes, well, a couple things. Let me just kind of explain the pilot itself as we have gone through it, mid-2015 when 

they started, and the recent probably two months we have made 

some pretty significant improvements. Part of what we try to eliminate is the manual handling of the product itself. So we get the advance electronic data. We provide it to Customs and Border Protection. They provide us a list of what they want us to extract. We 

were doing that in a manual fashion in terms of identifying the 

sacks and then identifying what we needed to do to extract those 

pieces. 

In today’s environment, when there has not been any experience 

and there has been improvements significantly to take that and 

now put it on the processing equipment, we have worked very 
40 

closely with the Inspection Service and our engineering systems 

now to be able to do this on our processing equipment. 

So one of the key things that will happen with this is it will be 

on equipment at JFK ISC. We also have connected the down-flow 

facilities that are connected to JFK where we are actually able to 

trap those pieces now. So much the same way that you heard from 

the UPS testimony, pretty much everything, and we do this very 

well on the domestic side of the network today. We are very good 

at this part of it, tracking bar codes. So we have the ability now 

to do that. The expansion is and our full commitment is to get 

those other sites up and running now that we have flushed through 

this as quickly as we can get them up. We need to do it in collaboration with Customs and Border Protection and, Mr. Perez may 

want to chime in a little bit. But we are very focused to get moving. 

It is ready to move forward and get expanded to the other four 

sites. We are very committed to getting that done. 

Senator CARPER. All right. Thanks. 

Mr. Schenk, give us a final 30 seconds, just a great takeaway. 

You were here 17 years ago. I want to make sure you are not here 

17 years from now. We probably will not be either. But give us just 

a great takeaway in terms of our to-do list here on our end, on the 

Congressional end. 

Mr. SCHENK. Well, I think, again, the key thing is passage of the 

STOP Act. Not only will it help with the problem, we also think 

it will actually help the postal operators in their negotiations with 

the UPU, that they will have legislative language that says we 

have a mandate, we have to do it. 

The other thing is if there was a way to maybe increase the 

amount of information that is shared. We have a great working relationship with CBP, but there are limitations in terms of if we 

knew more about maybe who some of the bad people were, we 

could build that into our systems, and we can shrink the haystack 

from both sides. 

Those would be the two things. 

Senator CARPER. All right. That is great. Thank you. I am going 

to be asking for the record if there are any amendments, any 

changes that should be made to the STOP Act, what is the rationale? What changes, if any, should we consider? And sort of 

prioritize those for us. That will be a question for the record for 

each of you. If you could do it, that would be great. 

Mr. Chairman, so far, we are halfway home, and this has been 

a great first half. Thank you. 

Senator PORTMAN. Thank you. Senator Hassan. 

Senator HASSAN. I will pass. Thank you. 

Senator PORTMAN. Well, let me just conclude by thanking our 

witnesses again, and I thank every one of you for what you are 

doing in your own way to try to push back on this epidemic, because each of you in your capacities are working on this issue. As 

I said, we have to figure out how to do it more effectively and faster. 

Let me end with a story. Yesterday we had our weekly Buckeye 

coffee, and we have Ohioans come in. A couple hundred come in 

sometimes, as was the case yesterday. Four rural letter carriers 

were there, and they were there from the union to talk to me about 
41 

postal issues. They talked about the STOP Act and talked about 

the need for more resources for Senator Carper’s efforts. He has 

been a leader on this over the years. 

Then two of the four took me aside privately. This is 50 percent 

of your rural letter carriers who came to see me yesterday and 

said, ‘‘You know what? I have a family member’’—one was a nephew, one was a son—‘‘who were addicts.’’ Recovering addicts now. In 

both cases, they had the opioid addiction. They are now in and out 

of recovery, which is not unusual. They both said to me, ‘‘You have 

to move forward with this. You have to continue your efforts.’’ 

So I would just tell you this is affecting everybody, including our 

families and our friends and our neighbors in every zip code, including the rural letter carriers who came to talk to me about another topic but ended up focusing on a personal topic, which is 

their deep concern about this issue. 

Thank you all for being here, and I appreciate continuing to work 

with you on this legislative initiative and stopping this poison from 

coming into our communities. Thank you. 

[Pause.] 

All right. The second panel has now joined us. We are going to 

move quickly here through the introductions. Each of you deserve 

a 20-minute introduction, but I am going to give you a shorter one 

today, with the hopes that we can get to questions quickly. 

First is Michael Botticelli, executive director of the Grayken Center for Addiction Medicine at Boston Medical Center. As some of 

you know, Mr. Botticelli has been at this a long time and is a real 

expert. He actually was the Drug Czar. He was the head of the Office of National Drug Control Policy (ONDCP) until just a few 

months ago. We are delighted to have you here, Mr. Botticelli. 

Second, we have Chief Thomas Synan. He is Police Chief for the 

city of Newtown in Hamilton County, Ohio. He has also been very 

involved in the Hamilton County Heroin Coalition Task Force. He 

is chair of the law enforcement sector of that task force. Everywhere in southwest Ohio people look to him for his advice on this, 

and he is going to be able to talk to us a little bit about what is 

happening on the street. 

We have Dr. Thomas Gilson, who is the Medical Examiner of 

Cuyahoga County. Previously, he was Chief Medical Examiner for 

the State of Rhode Island. He has a lot of experience. I told him 

today he provides us the best information because every month he 

gives us the data on what is happening in Cuyahoga County, broken down by area of the county, rural, suburban, inner city, ethnicity, age, and it is very helpful data. The bottom line is it affects 

everybody. It knows no zip code. 

Dr. Terry Horton is also here with us. He is the chief of the Division of Addiction Medicine at Christiana Care Health Services in 

Wilmington, Delaware. Previously, Dr. Horton served as Medical 

Director and Vice President of the Phoenix House Foundation in 

New York, well known. Most recently, he helped develop and 

launch the Opioid Withdrawal Pathway, a program designed to 

help screen, identify, and treat opioid-addicted patients who are admitted to the hospital. He also founded Project Engage and has 

been very involved in Delaware as the Chair of the Drug Overdose 

Fatality Review Commission. 
42 

1The prepared statement of Mr. Gilson appears in the Appendix on page 113. 

We really appreciate all four of you being here today as experts, 

and we would now ask you to stand so we can swear you in quickly. It is the custom of the Subcommittee to swear in all witnesses. 

I would ask you to raise your right hand and repeat after me. Do 

you swear the testimony you will give before this Committee will 

be the truth, the whole truth, and nothing but the truth, so help 

you, God? 

Mr. BOTTICELLI. I do. 

Chief SYNAN. I do. 

Dr. GILSON. I do. 

Dr. HORTON. I do. 

Senator PORTMAN. Thank you, gentlemen. Please be seated. 

Senator CARPER. Mr. Chairman. 

Senator PORTMAN. Yes? 

Senator CARPER. Could I just make a quick comment? Terry Horton is here representing Christiana Care, a large regional health 

care provider, and great work in this area. Terry is a leader. Sitting right behind him is Bettina Riveros, who at one time when I 

was Governor, she was my Deputy Legal Counsel, and she has 

gone on just to be a wonderful leader at Christiana in our State 

on a wide range of health care issues. 

And I think there is a young guy back there named Sebastian. 

We all rode down on the train together. Sebastian is 15 years old. 

He is Terry’s son, and we welcome him as well. We will be watching carefully to see if Sebastian’s lips are moving when his father 

speaks. 

Senator PORTMAN. Yes, thank you, and I am sure you attribute 

all of your success in life since then to Governor, now Senator Carper. 

Senator CARPER. She succeeded in spite of my mentoring. 

Senator PORTMAN. Let the record reflect the witnesses all answered in the affirmative with regard to the oath. 

Gentlemen, your written testimony, of course, will be printed in 

the record in its whole. We would ask you to keep the oral comments to five minutes so we have time for questions and a good 

dialogue. 

Let us start with Tom Gilson, if that is OK. Dr. Gilson, let us 

hear from you first. 

TESTIMONY OF THOMAS P. GILSON, M.D.,1 MEDICAL EXAMINER, CUYAHOGA COUNTY MEDICAL EXAMINER, CLEVELAND, OHIO 

Dr. GILSON. Thank you. Good morning, Chairman Portman, 

Ranking Member Carper, and other Subcommittee Members. My 

name is Thomas P. Gilson. I am the medical examiner from Cuyahoga County as well as the crime laboratory director, and I thank 

you for allowing me to be here to speak on this critical subject. 

If I were to tell you that a major catastrophe that would kill tens 

of thousands of people in the United States this year were to occur, 

how would the Federal Emergency Management Agency (FEMA) 

respond? How much money, how many people, how many resources 

would be put into action in this response? If this catastrophe was 
43 

allowed to happen again, with even more fatalities, how many more 

hearings would be called to determine what went wrong in the response? 

The opiate crisis should be thought of as a slow-moving mass fatality event that occurred last year, is occurring again this year, 

and will continue to occur next year. Each year is getting worse 

than the previous. In my home of Cuyahoga County, we will see 

approximately 800 drug-related deaths in 2017, which is an increase from our most devastating year, last year, 2016, when we 

saw approximately 660 people die from drug-related deaths, up 

from 370 the year before. 

Nearly 90 percent of these deaths will be due to opiates or 

opioids of some kind—prescribed pills from which the crisis originated and grew from, heroin, fentanyl, and now the newer analogs 

of fentanyl. It is a nationwide public health emergency which is 

simply out of control. Ohio was one of the hardest-hit States, but 

Appalachia, the Middle Atlantic States, and the New England 

States are also particularly hard hit. 

In the fall of 2011, my office alerted our county executive to an 

alarming trend of rising heroin-associated deaths. In the subsequent months and now years, we partnered with our county sheriff, 

Cleveland Police Department, U.S. Attorney’s Office, the county 

prosecutor, Addiction and Mental Health Services (ADAMS) Board, 

and our Board of Health to launch a community initiative which 

I am proud to say has attempted to combat this public health crisis. Partners were quickly added from the major medical institutions, including the Cleveland Clinic, Case Western Reserve University Hospitals, and our county hospital, MetroHealth Medical 

Center, as well as the Free Clinic, a free public health service provider, and set in motion some important pieces of response. We 

have drug dropoff boxes now to take back overprescribed prescription pain medication in over 50 police departments. Our naloxone 

distribution program is run out of the county hospital as well as 

the Free Clinic and the Board of Health. We also issue warning letters to released inmates who are at greater risk of overdose due to 

their abstinence while incarcerated, as well as patients leaving 

treatment centers. These folks are at risk because of decreased tolerance. The creation of our Heroin Death Review Committee allowed us to look at data from the overdose fatalities in an attempt 

to plan intervention strategies. 

We also held a Heroin Summit hosted by the Cleveland Clinic in 

November 2013. As a result, Law enforcement created specialized 

task forces that work with our medical scene investigators to begin 

investigations earlier and our Regional Forensic Laboratory provides highly accredited, timely, and efficient scientific testing. Prosecutors at the county and Federal level are now levying much stiffer charges against drug dealers. All of this work continues to implement a community-wide and community-based strategy that was 

created at the Cleveland Clinic Heroin Summit. 

When a heroin overdose occurs, individuals typically fall asleep 

and breathe more slowly and shallowly until, at last they stop altogether. During this progression, the dying sequence can be relieved 

by the heroin antidote Naloxone, which was made more readily 

available in Ohio and is an immediate first step in saving lives and 
44 

should be applauded. Cuyahoga County and the MetroHealth Medical Center partnered in 2013 to distribute Naloxone by prescription as was then allowed by law, and we have currently documented over 1,000 overdose reversals with Naloxone. Police departments, in a pilot program started in 2014 but ramped up in earnest 

last year, have documented another 300 reversals. These 1,300 individuals did not have to make a final trip to my office. The introduction of fentanyl and even more potent analogs like carfentanil 

(a large-animal tranquilizer) was initially seen in Akron and subsequently in our jurisdiction, have diminished the efficacy of 

Naloxone. Several doses may now be required, and the time window for administration is greatly shortened. This is a fundamental 

reason for the catastrophic mortality rise in 2016. 

Research conducted at the medical examiner’s office in my county, in collaboration with medical, law enforcement, and forensic 

partners, indicates that nearly 600 people died of heroin overdoses 

between 2012 and 2014. Some promising intervention points should 

be considered. At least 72 percent of all of these overdoses had 

been prescribed a controlled substance within two years of their 

death, and over 50 percent for opioids. 

Several of these people were ‘‘doctor shopping,’’; however, with 

the mandatory implementation of a prescription drug monitoring 

program (PDMP), Ohio Autormated RX Reporting System (OARRS) 

in our State, we are now moving in a positive direction to reduce 

this as an entryway for people to go into the illicit drug market. 

As a final example of how valuable information can be gleaned 

from death certificate and death review data is the fact that many 

of the individuals who came to my office had been in contact with 

the legal system and/or drug and alcohol treatment programs. 

There is a tremendous need for education and these opportunities 

are needed to maximize this for messaging. But it is naive to think 

that education and messaging would be effective if we do not adequately address the need for treatment options once the message 

has been delivered. People can recover from drug addiction with 

adequate support. 

While data and information are critical in helping to determine 

effective strategies, it has been particularly inspiring to see the 

sense of community in Cuyahoga County that has brought treatment prevention, law enforcement, prosecution, and medical examiners like myself together for a single purpose, which is to save 

lives. 

At the same time, however, our local resources have been 

stretched to the point of exhaustion. The Death Investigation System and local forensic laboratories are facing double-digit caseload 

increases annually, personnel shortages, equipment problems, and 

increasingly complex processes to support the fight, especially now 

with the fentanyl analogs entering our country. 

While we have interacted successfully with Federal partners, it 

is clear that the supply and delivery of the drugs to our communities continued nearly unabated, and treatment options, as I mentioned, are severely limited. Our community has added millions of 

dollars to this effort in the past several years. Our estimates are 

that there are enough people in my county to fill our football stadium every year, and that approximately a sufficient number of 
45 

people to fill our basketball arena transition over from the use of 

prescription opioids to heroin and fentanyl. 

That used to be a largely Caucasian majority of upwards of 85 

percent of victims. However, this is changing now, and it seems almost with purposeful intent. Cocaine is now being mixed into the 

fentanyl distribution and the analogs of fentanyl in an effort to introduce these drugs into the African American community. Cocaine 

had been the only drug where victims in our community were predominantly African American. That has changed since the introduction of cocaine into that supply distribution. And it is also of 

note that we have a rising percentage of African American deaths 

in our drug overdose crisis. 

The strategies to combat this crisis are not a matter of innovative creation but of sheer will, cooperation, and adequate resources. 

The will and cooperation I feel I see already in my county that the 

resources at a local level are depleted and overwhelmed. Treatment 

beds need to be opened and adequately funded. Our county executive, in cooperation with our mayor and local Alcohol and Drug 

Board, has created additional funding for treatment. 

The Institution for Mental Disease (IMD) exclusion, which limits 

the number of treatment beds to 16 for a substance abuse treatment facility, needs to be lifted, and I salute the bill currently offered by you, Chairman Portman, as well as your Ohio colleague 

Senator Brown, that will more than double the number of available 

beds. Interdiction agreements with China, Mexico, and Canada 

need to be strengthened, and delivery of these substances through 

the U.S. Postal Service and other delivery services needs to be 

squeezed off. I appreciate your cosponsorship of S. 708 to this purpose. 

I am sorry to go over time, but to add this: There is a national 

crisis in my field in death investigation. My field of specialty, forensic pathology, is in dire need. There are less than 500 board-certified, full-time forensic pathologists practicing in the United 

States. Currently, on my professional organization’s website, 28 offices are seeking to hire additional forensic pathologists. I have the 

privilege of heading the oldest forensic pathologists training program in the country. There are only 35 such programs in existence 

and they are not funded by Medicare, which is unlike any other 

medical training specialty. Our program graduates one or two doctors a year in a system that can only produce a few dozen pathologists annually. We rely on accurate data around mortality to define 

this crisis and I think it will serve as a significant measure of our 

success or failure, and that depends on a competent death investigation. It is essential that additional support be given to these 

training programs as well as to doctors already practicing in the 

field. 

All of these actions are beyond the ability and authority of a local 

county like mine. We need your continued and renewed assistance, 

resources, and commitment to all phases of this fight: prevention, 

education, treatment, enforcement, and recovery. 

As I said, I am sorry to go over time. It is a very important topic 

to me. I thank you for your time and consideration. I would be 

happy to answer any questions. And we also provided a packet of 
46 

1The prepared statement of Mr. Botticelli appears in the Appendix on page 146. 

information which summarizes even more. I could have talked 

longer. 

Thank you very much. 

Senator PORTMAN. Thank you, Dr. Gilson. Mr. Botticelli. 

Senator HASSAN. Mr. Chairman? 

Senator PORTMAN. Yes? 

Senator HASSAN. Just because I have to leave and I wish I could 

stay for all of you, but I just also wanted to thank Dr. Gilson, who 

was deputy chief medical examiner for the State of New Hampshire 

for some time. And thank you so much for your work, and thank 

you so much for your continued work, and thank you to all of the 

panelists. And, Mr. Botticelli, I am sorry I am going miss you, but 

we have talked before and we will talk again. 

Thank you so much. 

Senator PORTMAN. Thank you, Senator Hassan. 

Mr. Botticelli, and remember, your full statement will be made 

part of the record. 

TESTIMONY OF THE HONORABLE MICHAEL BOTTICELLI,1 EXECUTIVE DIRECTOR, GRAYKEN CENTER FOR ADDICTION 

MEDICINE, BOSTON MEDICAL CENTER 

Mr. BOTTICELLI. Thank you. Chairman Portman, Ranking Member Carper, Senator Hassan as you leave, thank you for the opportunity and the invitation to be here today and for your ongoing 

leadership in this epidemic. 

I think we all know the opioid epidemic is the pressing public 

health issue of our time, and in many respects, a public safety 

issue of our time. 

The 2016 National Survey on Drug Use and Health estimates 

that approximately 2.1 million people in the United States have an 

opioid use disorder. In 2015, the last year that we had complete national statistics, 91 people a day died from an overdose of opioids, 

including prescription pain medication, heroin and/or fentanyl, resulting in over 33,000 deaths in 2015 alone. In Massachusetts, 

1,900 people died of an overdose in 2016, and that is up from 742 

just from 2012. 

In addition to addiction and death, we know injection drug use 

associated with this epidemic has been linked to dramatic increases 

in viral hepatitis across the country along with local outbreaks of 

human immunodeficiency virus (HIV). A recent analysis done by 

the CDC showed that there are at least 220 counties, mostly in Appalachia, that are at significant risk for another outbreak similar 

to the one that we saw in Scott County, Indiana, two years ago. 

Over the past few years, we have seen the emergence of synthetic opioids like fentanyl. The CDC estimates that overdose 

deaths attributed to synthetic opioids other than methadone increased by over 72 percent from 2014 to 2015. Reports from the 

DEA as well as State law enforcement indicate that these deaths 

have been associated with law enforcement seizures testing positive for fentanyl. This increase is not a result of prescribing 

fentanyl, which indicates this is largely illicitly manufactured. Domestic law enforcement seizures have increased by 426 percent 
47 

from 2013 to 2014. Analysis was limited to those States, like Ohio, 

that have excellent or very good reporting which means that overdose deaths are reported with the specific drug involved. Twentysix States reported statistically significant increases from 2014 to 

2015 with States in the Northeast and Midwest experiencing the 

highest increases. 

A recent analysis of overdose deaths in Massachusetts showed 

that deaths involving fentanyl rose from 32 percent in the 

2013–14 period to 72 percent in the first half of 2016. 

Fentanyl is often mixed with heroin and cocaine with or without 

the user’s knowledge, usually without. As we have seen in some 

high-profile deaths, it also can be disguised as prescription pain 

medication and again taken without the users knowing that it contains fentanyl. The supply, as we have discussed, appears to be 

largely illicitly manufactured in China, either directly shipped to 

the United States, via both open and dark web sources, or shipped 

to Mexico where it gets mixed in with heroin before transport to 

the United States. 

I will not go into detail for lack of time, but I think you all know 

the Administration’s response to these efforts, and underpinning all 

of those efforts is ensuring people who need treatment have timely 

access to high-quality care, including medication-assisted treatment. 

The Affordable Care Act contributed to perhaps the greatest expansion of treatment by ensuring substance use disorder treatment 

was one of the 10 essential benefits that Medicaid expansion plans 

and marketplace plans had to cover. It also ensured that those benefits be offered on par with the Federal Mental Health Parity and 

Addiction Equity Act. 

Again, for lack of time, I will not go into detail, but I am very 

proud of the accomplishments that we were able to make with Congress in terms of the passage of the Comprehensive Addiction Recovery Act (CARA), rescinding the Federal ban on the programmatic aspects of syringe service programs. We accomplished a 

lot in our time together here in Washington. But we still have a 

long way to go. 

So I will focus the remainder of my remarks on what I think are 

recommendations as we look on how we deal with fentanyl. 

Continuing to enhance our intelligence and information gathering on the manufacturing and distribution of fentanyl is critical. 

And while I was very appreciative of the intelligence community’s 

(IC) call for better information, there are still many unanswered 

questions. I was very happy to hear that the Director of National 

Intelligence (DNI) looked at synthetic opioids as a major threat. 

Quite honestly, I was very frustrated during my time at ONDCP 

that I did not know we had fentanyl and things like carfentanil 

until we saw local outbreaks in the United States. Our intelligence 

community is too good for us to be caught unaware in terms of 

what is coming at us. 

Since fentanyl is much harder to detect and can present a hazard 

to State, Federal, and local law enforcement, we need to promote 

better ways to expand current drug-testing technology and continue 

to develop detection capabilities. 
48 

1The prepared statement of Dr. Horton appears in the Appendix on page 152. 

We need to continue to provide fact-based handling instructions 

to law enforcement, Border Patrol, and others who may come in 

contact with fentanyl. 

We need to continue our engagement with China and press them 

for additional action to schedule fentanyl analogs and to take down 

illicit manufactures and shippers. 

There is also a significant amount of variability of standard testing of fentanyl, with law enforcement, criminal justice systems, 

coroners and medical examiners, and treatment programs. They 

need to incorporate fentanyl into their drug-testing panels. 

With public health experts, we need to develop and distribute informational material on how users can minimize their overdose 

risk in areas where fentanyl might be present. 

We need to expand the use of Naloxone by anyone who is in a 

position to witness or reverse an overdose. Because of the potency 

of fentanyl and what appears to be a pattern of drug users injecting alone, the period of time we have to reverse an overdose has 

shortened. 

We also need the Federal Government to deploy rapid response 

teams to our communities like we do with other diseases so that 

communities have the investigatory tools that they need to examine some of these outbreaks and the causes behind it. 

We need to expand syringe service programs and other programs 

that engage active drug users to promote safer injecting, distribute 

Naloxone, and minimize overdose risk. 

Most importantly, we need to preserve the coverage gains made 

through the Affordable Care Act, particularly Medicaid expansion 

and other Federal grant programs. Even with these provisions, 

timely access to quality care remains an issue for many, particularly in rural communities. 

Thank you for your time, and I look forward to your questions. 

Senator PORTMAN. Thank you. Dr. Horton. 

TESTIMONY OF TERRY L. HORTON, M.D.,1 CHIEF, DIVISION OF 

ADDICTION MEDICINE, AND MEDICAL DIRECTOR, PROJECT 

ENGAGE, CHRISTIANA CARE HEALTH SYSTEM, WILMINGTON, 

DELAWARE 

Dr. HORTON. Thank you. Thank you, Chairman and Senator Carper. 

First, I would like to say I think this issue of addressing fentanyl 

is important. Fentanyl certainly exacerbates any issue I have to attend to at the hospital in trying to help individuals get into care. 

It just creates a rapid spiraling of addiction, much more so than 

we would see otherwise. 

In Delaware, 25 percent of our individuals who die from drug 

overdose have fentanyl in their blood at the time of death, so when 

we look at the potential for damage in our State if the presence of 

fentanyl reaches the levels in Massachusetts, I think there is going 

to be a real catastrophic increase in the coming year. 

Having said that, as someone who sits in a hospital, works in an 

inpatient setting and in the emergency room and clinics, I want to 

share some of the lessons I have learned over the past 25 years. 
49 

This is a horrific epidemic. It strikes across the board. I take care 

of young mothers who have given birth, high school kids who are 

pole vaulting champions and wrestling champions, grandparents, 

couples, people of all races, all ages. What they share is a horrific 

addiction. Their brains have changed. Their motivational circuits 

have been distorted. And when they stop using the drugs, they 

have this new onset of withdrawal, a withdrawal that is really like 

primal misery. Withdrawal is like a wall that prevents them from 

moving through that wall to go on to care. They will stay outside 

of that care and avoid it at all costs because they cannot manage 

the withdrawal, they cannot go through that wall to the other side 

where there is care. 

That is our reachable moment. That is also what we can leverage. And we have done that in the hospitals, and we have done 

that in jails. So when someone is in a hospital and they can no 

longer be on the outside, and they are desperate to avoid withdrawal, we can address their withdrawal and we can treat it aggressively with medications like Suboxone. We have been able to 

leverage that reachable moment and get them into treatment. 

Two-thirds of the people that I see in the hospital are very agreeable to go into long-term care. Two-thirds. They do not come into 

the hospital looking for that care. They have an infected leg or an 

infected heart, but they use that opportunity to get into drug treatment. It is really remarkable. Two-thirds of individuals I see are 

actively looking to go into drug treatment when I offer it and I address their withdrawal and begin treatment. 

Of those individuals, remarkably, nearly 80 percent show up to 

their community care provider when I have inducted them on to 

Suboxone or methadone in the hospital. So the hospital is a reachable moment. And of those individuals, 70 percent are there in 

treatment a month later. So what I am telling you is that when individuals who are addicted to opiates, who come into our hospital 

system, it is a reachable moment to address their withdrawal, and 

we can use that leverage to get them into treatment—and they 

stay there. If you are on drug treatment, if you are on medicines 

like Suboxone, which block opiates, and you use opiates, you are 

not going to overdose. This is really about safety. I tell each of my 

patients every day when I see them in the clinic—yesterday I had 

clinic, and this is what I said: ‘‘Take your Suboxone today and tomorrow, and those days we do not have to worry about you overdosing.’’ It is a pretty simple, straightforward safety message. 

Having access to that care and medication is really critical to 

what I am trying to do as a doctor: to help individuals get into care 

and stay in care so they do not overdose and they do not die. And 

we are pretty fortunate. In Delaware, we have been able to expand 

outpatient slots for primary care—or for substance abuse care really—by the thousands. When I identify an individual in the hospital, 

I have no difficulty getting them into care the next day in a community setting. It has to be that contiguous, or I lose them and 

they relapse. 

So it is remarkable that I am able to do that, but I am able to 

do that because that care is available, and that care is completely 

and wholly dependent on Medicaid. Without Medicaid, that care 

would collapse. 
50 

1The prepared statement of Chief Synan appears in the Appendix on page 157. 

And so, I can tell you what I am really fearful of. I am fearful 

that I know how to address this opiate epidemic, I know how to 

treat the patients that I have who are addicted to heroin and to 

other drugs. I know how to get them into a safe place, but I am 

fearful that I will lose the tools and the medicines I need to keep 

them safe. And I am really fearful that some of the cuts that have 

been proposed will completely gut the system that I rely on to treat 

my patients and keep them alive and help them get to a better 

place. 

So basically I am saying, please, it is critical. Do not take away 

my ability to treat my patients and keep them safe. They depend 

on me, and I am depending on you to really preserve the system 

of care that I have been able to work with and make improvements 

to in order to care for my patients. Without it, I think this war is 

lost. 

Senator PORTMAN. Thank you, Dr. Horton. Chief Synan. 

TESTIMONY OF THOMAS SYNAN, JR.,1 CHIEF OF POLICE, 

NEWTOWN, OHIO, POLICE DEPARTMENT 

Chief SYNAN. Thank you, Chairman Portman and Ranking Member Carper, along with the Subcommittee, for giving me this opportunity to discuss this very important topic of how synthetic drugs 

such as fentanyl and carfentanil are destroying the lives of loved 

ones and our communities. In my 24 years of law enforcement, I 

have never seen a substance cause such damage and devastation 

with its death rates that have risen to levels higher than car accidents and homicides combined. I have witnessed the power of 

drugs in my small community watching an entire family from the 

mother to her three sons wiped out. Three brothers, an entire generation gone because of drugs, the last two brothers due to heroin. 

Events such as this led us to form the Hamilton County Heroin 

Coalition at a time when we were calling this an epidemic, with an 

average of 20 to 25 overdoses and one to two deaths a week, an 

epidemic. In July 2016, I received a call from the Greater Cincinnati Fusion Center, a part of Homeland Security, a center that 

was originally designed after the 9/11 attacks for law enforcement 

to share intelligence on potential terrorist situations which could be 

analyzed and shared with local, State, and Federal law enforcement along with the public. Recognizing the centers ability to analyze data and share it quickly among various agencies, we adapted 

its use for heroin, tracking overdoses, locations, and intelligence 

that could track trends on the street. 

At 10 p.m., that call told me, ‘‘Tom, there is a new drug on the 

street called carfentanil.’’ I asked, ‘‘What is carfentanil?’’ The response was, ‘‘We are not sure; it is used to knock out large animals.’’ I replied, ‘‘Like a pig?’’ And he responded, ‘‘No. Elephants.’’ 

We passed this information on to the coroner and the Hamilton 

County health commissioner trying to obtain as much information 

as we could to try to figure out what the introduction of carfentanil 

on our streets would mean. What we learned about this drug was 

frightening: it is at the top of the fentanyl/opiate chain, potentially 

used in some chemical weapons, a drug not intended for humans, 
51 

so powerful that the equivalent of two grains of salt had the potential to kill a human. This drug, 10,000 times more powerful than 

heroin, was now on our streets leading us to issue a public warning 

due to concerns not only for the user but first responders, hospitals, 

treatment centers, and the public—all who could unknowingly be 

exposed to this extremely dangerous synthetic. We were so concerned for the safety of law enforcement that we recommended 

stopping field testing of heroin, which is a process needed to develop probable cause to arrest a person for heroin, because the officer’s safety was the priority over enforcement. This warning has 

reached other States such as Georgia and Florida who have also 

stopped this practice to ensure the safety of their officers. With all 

the dangers already facing law enforcement, this danger which 

could be undetected until it was too late was a danger that concerned the most hardened police veteran and led police administrators to modify policies to protect their officers. We knew this drug 

was strictly controlled and monitored in the United States, and 

with the assistance of the DEA, we determined it was not coming 

from sources within the United States. 

We could have never anticipated that our epidemic would reach 

levels more along the lines of a pandemic and become the new normal. In the week of August 19–27, 2016, an event occurred that 

would forever change the heroin epidemic in our area when the 

hardest hit, Cincinnati, experienced nearly 200 overdoses and three 

deaths in one week. Seeing and hearing from dealers and users 

alike that there was nothing on the streets other than synthetic 

drugs like fentanyl and carfentanil, we experienced the literal shift 

from the ‘‘organic’’ opiate of heroin to the synthetic opiate of 

fentanyl, all its derivatives, and carfentanil. 

This shift in synthetics is testing the limits of users, first responders, the systems of government, hospitals, and the spirit of 

each person who, no matter drawn in by choice or necessity, is to 

the point of breaking. I not only witness this devastation but the 

determination of those same people who day in and day out try to 

keep up with the new normal, the new average of 50 to 70 

overdoses and with four to five deaths a week. Moments of spikes 

where 70 overdoses occur in one weekend, 11 people die in one 

weekend, and multiple overdoses at the same time in the same location. At times overdoses reach nearly 40 in one day, stretching 

the resources of even large police and fire departments such as 

Cincinnati, who in one district with 20 officers had 16 on overdoses 

and four on shootings, causing every officer to be unable to respond 

to other calls. In 2012, our area had seven deaths that were 

fentanyl related. In just three years, that number exploded to 238 

in 2015. 

Heroic efforts made by many who initiated innovative programs 

such as quick response teams that try to connect users to treatment, the Coalition issuing Narcan to every first responder who in 

19 months has used over 7,500 Narcan kits. The sheer volume of 

numbers has lead us to follow the mantra of the starfish parable 

where a young boy was walking down the beach where thousands 

of starfish had washed up. The young boy would pick up a starfish 

and throw it into the sea and go to the next one. An old man seeing 

this stopped the boy and said, ‘‘Young man, there are too many to 
52 

make a difference. You cannot save them all.’’ The young boy 

picked up a starfish, throwing it back into the sea, replied, ‘‘I saved 

that one.’’ This description we follow is beautiful in its nobility and 

heartbreaking in its reality, describing where we are right now 

with this epidemic. 

But no matter how great our efforts, our initiatives, our determination, the tremendous influx of such powerful synthetics such 

as fentanyl—which illegal labs have altered the molecular structure into even more powerful derivatives force us to change oure 

beliefs in order to keep up with its power. Our coroner’s office has 

identified at least 10 variations of fentanyl—and the current ultimate on the opiate scale of carfentanil have rendered each initiative less effective. The original two milligram Narcan we issued to 

over 1,000 police officers, is now obsolete and replaced with a higher concentration of a four milligram dose of Narcan, which often 

due to the strength of the synthetic, requires multiple doses. It is 

more common to hear of unconscious users taken to the hospital 

and placed on a constant Narcan drip in order to keep them alive. 

These synthetics are now so ingrained in the user in our area 

that when we think the situation cannot get more difficult or cause 

any more fear, dealers insensitive to the damage they are causing 

to the user and our communities have now begun to place these 

synthetics in other drugs like cocaine. This will not only cause 

more overdoses but deaths due to the cocaine user’s body not being 

accustomed to not only general opiates but especially ones as 

strong as carfentanil. Carfentanil is now so common in our drug 

supply, a staple in the heroin supply, is now expanding. Just a couple weeks ago, four people in Cincinnati who bought what they 

thought was just cocaine overdosed. Two died on the scene; two left 

in critical condition on Narcan drips due to that cocaine containing 

fentanyl and carfentanil. 

Since I submitted this report last week, another person in that 

incident died. So three have died and one is still hospitalized at my 

last check. 

That same week in my small community, a mother drove her 10- 

month-old baby into a driveway where she got out and collapsed. 

Neighbors called 911, brought the baby inside where the officers 

arrived, and the mother regained consciousness. She believed she 

had only purchased heroin, but was later found that she actually 

had been given a mixture of cocaine, fentanyl, and carfentanil. And 

since I submitted this report last week, two officers and I stood 

over the body of a 26-year-old at that same location who died from 

a suspected fentanyl overdose. 

I commend this Committee for taking the time to hear, investigate, and look into ways to help reduce these powerful synthetics 

from entering our country, drug supply, and our communities. I 

plead with this panel to do all it can to help us by stopping this 

poison from even getting into the country. Although this will not 

stop addiction or stop every supply, each intervention that prohibits these synthetics from reaching the streets means first responders can get relief from the overwhelming numbers which has 

caused such stressors on them and our system. We have coined a 

term while working with the Ohio Attorney General’s office, called 

‘‘first responder fatigue.’’ 
53 

Take this deadly ingredient from those who push these drugs on 

our streets so their potions become less powerful. Take this tool 

away from them so that the tools we are using can be given the 

chance to work. Reduction from these powerfully devastating synthetics would mean less people would overdose and the number of 

deaths would be reduced. It is never lost on us that each one of 

those numbers is a person who has a mother, father, brother, sister, son, or daughter who will forever grieve the loss of their loved 

one. 

Thank you for allowing me to speak on this subject. I commend 

you for your compassion to want to help all of us in making the 

lives of those we serve better. 

Thank you. 

Senator PORTMAN. Thank you, Chief, and thanks to all four of 

your for some very powerful testimony. 

I was struck by your testimony, Chief, about law enforcement 

and, as you said, trying to keep up with the changing drug mix and 

specifically the move to synthetic opioids, carfentanil and fentanyl 

in particular. I am thinking about how law enforcement approaches 

this. Now you have a situation where, through the U.S. Mail system, someone can at their post office box pick up fentanyl from 

China, use it as an individual, and there is no drug dealer for you 

to go after. 

Now, some of these individuals also become drug dealers, as you 

said, and yet it is a different situation than being able to go after 

the source because the source is coming in through the U.S. Mail. 

You talked about tools. Earlier, we were talking to law enforcement 

folks, and CBP said they want the tool of being able to get advance 

electronic data so they can identify these packages. You also said 

you want to take this tool away from the traffickers, the tool of 

being able to ship this stuff into our communities through the mail 

system. 

So I would ask you, given your experience and given your background in this, and seeing what is going on, would it be helpful at 

a critical choke point like these International Service Centers we 

have talked about here today to be able to stop this poison in part 

to be able to keep the volume down, to avoid the first responder 

fatigue you talked about, but in part to raise the cost, the risk to 

the trafficker of being caught, but also the cost of this by reducing 

the supply? 

Chief SYNAN. Yes, Senator Portman, it would definitely help cutting off that supply. There is very little risk for the dealers right 

now. There is quite a bit of reward. And the problem with it coming through the mail is that it is not like in the 1980s with crack 

where you had major gangs that were mostly pushing the crack cocaine, and once you identified the gang, you cut the head off the 

snake, and the rest of it collapsed. 

Here it is everywhere, with hundreds of dealers, and not necessarily in a network or sourced in one area. So it makes it very 

difficult for enforcement. 

I do want to say, however, that I want to caution that we do not 

repeat history. In Ohio, we did a great job of shutting down pill 

mills and doctor shopping. And, inadvertently, that created part of 

this epidemic when we had a segment of society that was left out 
54 

there opiate dependent. And I want to be careful that we not just 

shut off the supply, which is an incredibly important part of this; 

it would give first responders that chance to breathe. But I also 

want to make sure that while we are doing that we still have the 

resources on the back end. Part of the problem we are facing with 

this epidemic is if you can get someone who is opiate addicted into 

treatment, often there is not space available. In addition, there is 

discussion of medically assisted treatment and the signs show that 

that is effective. But we also need doctors and nurses and we need 

the facilities. So not only is that choke point important, but we also 

need to work on the issue of having those people who are addicted 

get long-term care in order to reduce the demand. In my belief, 

once we reduce demand then we will reduce supply. 

Senator PORTMAN. That is a great point, and I was impressed 

with Dr. Horton’s health care system that he has the ability to take 

somebody who is in need of treatment, and within 24 hours get 

them into treatment, which, frankly, is not the case in many places 

in Ohio, particularly in our rural areas. We have a real issue with 

the availability of treatment, and longer-term recovery, which, as 

you know, I have been focused on because I think that leads to better results. I think the law enforcement system can lead to better 

results, too, by supporting our drug courts more, as we do. I know 

you are involved with that as well. 

Dr. Gilson, you talked about what you are facing, and specifically 

you talked about the forensic pathologists being just overwhelmed. 

You and I talked a little about this prior to the hearing as well. 

One thing you said to me was that at a death scene where someone 

had overdosed from fentanyl, your people sometimes find a package, literally a package from China at the death scene. Again, I 

think this is just an extraordinary change from what you are used 

to with cocaine or, for that matter, with heroin coming over land 

and being sold at the street corner in Cleveland, Ohio. I was struck 

by that. 

Can you talk to us for a second about what you see happening? 

I think, as I told you earlier, you have the best data, at least in 

Ohio, and for 2016, unfortunately, you were pretty accurate that 

there would be an increase; the number of deaths from fentanyl 

was 399, as I recall, or 400. 

Dr. GILSON. Yes, that is true. 

Senator PORTMAN. Since you do keep this accurate data on 

overdoses and fentanyl-related deaths, what trends are you predicting for 2017 as compared to the 399? What do you project for 

2017? 

Dr. GILSON. Senator, I think we are already far enough into 2017 

that we can make some predictions. One is that the crisis is going 

to get worse. We are projecting an increase from 660 total deaths 

up to close to 800. I think most of that, again, is going to be driven 

by fentanyl, and I think the other thing that everybody in the room 

should be incredibly concerned about is what is going to be the impact of the analogs of fentanyl. We had 54 deaths in 2016 related 

to carfentanil just in my jurisdiction. 

Since the beginning of 2016, we have identified at least 16 to 17 

different analogs of fentanyl, and many of these, like carfentanil 

and 3-methyl-fentanyl, are far more potent than fentanyl. Fentanyl 
55 

is already a bad drug. What concerns me is at some point if these 

drugs start to replace fentanyl in our community, these numbers 

will take off again. 

To echo kind of what the chief said, we started with diverted prescription drug medication. In about 2011, what my office saw was 

a transition away from prescription drugs such as oxycodone, which 

appeared to plateau, then heroin took off dramatically. And that 

was our trend up until 2015. When heroin got started, actually it 

looked like they were going to go down because of the Naloxone 

and education programs. But then we caught a tidal wave of 

fentanyl, another more potent drug, making 2016 a uniform disaster in Cuyahoga County. We nearly lost twice as many people. 

These are hundreds of people dying of drug overdoses. 

If carfentanil becomes the new fentanyl in 2017, I shudder to 

think how much worse that can be. 

Senator PORTMAN. Dr. Gilson, from your experience, is the 

carfentanil also coming through the mail system? 

Dr. GILSON. I think, this is, again, partly what I can tell you 

from death scenes and partly what I can glean from the collaborations we have with particularly the Drug Enforcement Agency. Yes, 

my investigators by happenstance will sometimes identify computer 

records and/or packaging that clearly show that these drugs are 

coming from overseas. And the concept that a lot of these drugs are 

coming from China is something that our DEA liaisons completely 

support. The idea, too, that—and one of the Senators mentioned it 

earlier—maybe the drugs come to this country and then get rerouted into Mexico I think is also true, because in the heroin epidemic, the Mexican production went up dramatically to the point 

where they became the second largest heroin producer in the world. 

That distribution system is definitely in place, and I think fentanyl 

can follow the same distribution system. 

So I do think that these are drugs that are coming from overseas, 

primarily from China, and are being sold in our country really almost on a basis that could be considered an act of terrorism. 

Senator PORTMAN. That is an interesting comment given what 

we said earlier about what Mr. Botticelli said with regard to the 

DNI, listing it this year for the first time ever last month in his 

World Assessment. He put synthetic opioids into an State context. 

Senator Peters. 

OPENING STATEMENT OF SENATOR PETERS 

Senator PETERS. Thank you, Mr. Chairman. And thank you for 

calling this very important hearing. Opioid abuse in Michigan is 

growing at an alarming rate, as it is around the country, and it is 

important for us to get to the bottom of this and understand how 

we can deal with it. I appreciate your leadership on this issue over 

the months and years that you have been working on this. Certainly thanks to each of the panelists for your compelling testimony 

as well in dealing with this. 

My first question really deals with the underlying substance 

abuse and the medical treatment necessary to treat this as a medical issue. Certainly, it is a law enforcement issue, Chief, but this 

is a public health issue first and foremost that we have to deal 

with. Whenever we are thinking about public health, we must 
56 

think about our health care policies, and in particular the Affordable Care Act with its expansion of Medicaid, which has certainly 

been significant in my State. Medicaid expansion has led to over 

600,000 individuals now having health care coverage where they 

did not have it before. And part of the Affordable Care Act is coverage for mental health as well as substance abuse, which gets to 

the heart of this problem. Since the ACA’s Medicaid expansion 

went into effect, I think more than 1.6 million Americans have now 

gained access to substance abuse treatment. 

So, Mr. Botticelli and Dr. Horton, could you speak to how individuals enrolled in Medicaid are using the program and whether or 

not we are seeing an actual impact on folks who are suffering from 

substance abuse problems? 

Mr. BOTTICELLI. Sure. Thank you, Senator. One of the longstanding issues with substance use is access to treatment. You 

would think I would know how to do this by now. What we have 

sought for a long time is that when national surveys look at why 

people are not able to access treatment, not having adequate access 

to insurance coverage, and being underinsured are some of the biggest reasons. And you are right, the Affordable Care Act I think did 

a number of things as it related to increasing access to care and 

made substance use disorder treatment and mental health treatment one of the essential health benefits that were required by 

Medicaid expansion and by ensuring that those benefits were on 

par with other medical benefits. 

We have seen some remarkable results as it related to increased 

access to care under the Affordable Care Act, and I think your 

point about particular the Medicaid expansion population, which 

we knew had higher prevalence of substance use disorders in the 

general population. So we have seen remarkable results, and quite 

honestly, remarkable results in those States that have been dramatically impacted by this epidemic like West Virginia, Kentucky, 

New Hampshire, and Massachusetts. We have seen an incredible 

increase in people’s ability to access care to do that. 

I just want to make two quick points. The other important point 

here is that people with substance use disorders often have comorbid mental health, and, quite honestly, other health conditions. 

So it is not just accessing care for their substance use disorder. 

They need care for their hepatitis. They need mental health coverage. 

And the last thing I will say is I really worry about not just people losing coverage, but the stability of our treatment infrastructure. Some of these folks can tell you that these programs operate 

on very thin margins, and I worry that we are even going to have 

a treatment infrastructure for those remaining people who can access CARA if they are not able to bill insurance. 

Thank you. 

Senator PETERS. Anybody else? Dr. Horton. 

Dr. HORTON. Yes, thank you. As I mentioned, in our system we 

have developed some very unique partnerships with community 

providers. We now screen 30,000 admissions to our medical hospital, the largest in Delaware, identify those who are opiate dependent quickly around withdrawal, and treat that, and they are 

agreeable and go into care as outpatients in the community. 
57 

That care is predominantly Medicaid, so our largest community 

provider program called Connections has the largest footprint in 

the State, and developed that footprint because they had a reliable 

funding stream. 

Now, it is not only a funding stream that cares for Medicaid patients. It covers all patients. They are really a quality provider. But 

the bulk of their revenues—what allows them to exist—is that they 

have a reliable revenue stream. And because of that, I am able literally—and as I said, my record is actually 12 hours—to identify 

somebody and get them into treatment in the community on a medicine like Suboxone. And I can do that because the individual is 

covered. For the most part, that coverage is Medicaid. If Medicaid 

goes away, that collapses, and, frankly, the substance abuse infrastructure in Delaware collapses. So while I will identify individuals 

in the hospital, I will not have anywhere to send them. They will 

leave the hospital. They will relapse within hours to days, and they 

will be back in the hospital. And actually we will return to the days 

of the revolving door after they have, astronomical cost of caring 

for these individuals at places like my hospital and health system 

and we will never attend to the root cause issue. 

The big difference these days is the volume of heroin. It used to 

be once upon a time individuals used one, two, five bags a day. 

Now it is bundles. Each bundle is 13 bags, 50 bags a day. And I 

really think of it as Russian roulette where, instead of bullets, it 

is bags of heroin. If any of those bags has fentanyl in it, that person dies. It is amazing. 

So we are in the middle of all this and because I have access, 

ready access to substance abuse treatment on demand, I am able 

to make a difference. And I am clear that those individuals who are 

taking their Suboxone are not overdosing. I know because they 

come in week after week. 

Senator PETERS. Thank you. Chief, you are—— 

Dr. GILSON. I am sorry, Senator. Can I add a different perspective on this, too? 

Senator PETERS. Yes, please. 

Dr. GILSON. We do not track it specifically. But we go out to respond to death scenes and I think one of the most heartbreaking 

things we see is an individual who has been seen in an emergency 

department within weeks to sometimes days for a drug overdose 

who now is dead of a drug overdose. These are the people Dr. Horton does not see. They do not make it back to treatment. They die, 

and we do not have the capacity in my county to send these people 

when we have their captive attention—they have just nearly 

died—to treatment. We send them back on the street, like Dr. Horton said, to try and see if they can work something out. 

Anything like Medicaid expansion being eliminated that limits 

people’s access to health care, I cannot see any good coming from 

that in this crisis, especially with its mortality. 

I am sorry. Thanks for the time. 

Senator PETERS. I appreciate those comments. Now, Chief, you 

are at the front lines. Thank you for your service on the front lines. 

I would assume you would concur. 

Chief SYNAN. Absolutely. Law enforcement, I am very proud of 

my colleagues who have taken the lead on this. But the problem 
58 

is we are taking the lead on something that really is a public 

health issue. You are taking law enforcement, who is taking programs like quick response teams, trying to get addiction specialists 

out there. Narcan, we have become paramedics. It is not uncommon for officers to take users to treatment. 

So it is well outside of our realm to be doing this issue, but for 

us, we have now become somewhat addiction specialists. And for 

law enforcement to talk about that, we should not be decreasing 

Medicaid. That tells you how important this is to us, because, 

again, in order to reduce that demand, which would in turn reduce 

that supply, we have to get people into treatment. And one of the 

programs that our teams are doing out there in the Hamilton 

County area is signing people up for Medicaid to try to get them 

into that treatment. 

These are individuals who are walking with that user to try to 

get them into treatment, and if Medicaid is gone, that would have 

a significant impact. It is already difficult enough. It is not uncommon for us to find a user, call numerous treatment facilities, be 

told there is a bed open, drive them up there, to find out that bed 

is gone. So it is difficult enough. Taking away Medicaid would 

make it even more difficult. And like I said, we would be spinning 

our wheels. 

We are already like a mouse on a wheel trap spinning as it is. 

Taking away the tools is just making it more difficult, and we will 

continue to dig ourselves in a hole. 

Senator PETERS. Thank you for your testimony, all of you. I appreciate it. 

Senator PORTMAN. Thank you, Senator Peters. 

I am going to turn the gavel over to my colleague—— 

Senator CARPER. Big mistake. 

Senator PORTMAN [continuing]. And ask the Ranking Member to 

conduct his final questions and then close this out. Again, I want 

to thank the four of you for being here and for your work every 

day. All four of you are in the trenches, on the front lines. Thank 

you for helping to reverse this tide, which, unfortunately, right now 

is moving in the wrong direction. 

Thank you, Senator Carper. 

Senator CARPER [Presiding.] Mr. Chairman, before you walk out, 

let me just say, I will say this to your face, not behind your back. 

Thank you for your sustained, continued leadership on this. Maybe 

we can use the work, the effort that you have led, along with Amy 

Klobuchar and others last year, and to this year on CARA and 

other initiatives. If we can work that well across the aisle on an 

important issue, maybe we can somehow, particularly on the piece 

of making sure if folks show up at a hospital and they are ready 

to get treatment that they actually have access to treatment, how 

important that is. We have got to focus our attention on that as 

well. But thank you so much. 

I want to come back, Dr. Horton—I know this has been mentioned before. Explain to the folks maybe not just here in this room 

but around the country who might be following this, how is it in 

Delaware, when somebody shows up at a hospital, they have had 

an overdose, and they will only be there for a brief moment, min-
59 

utes, hours, when they are ready to go, they are ready to start 

treatment—and the opportunity and reachable moment will be lost. 

Dr. HORTON. Yes. 

Senator CARPER. And within 24 hours or so, we oftentimes have 

the ability to place them in treatment. 

Dr. HORTON. Yes. 

Senator CARPER. How are we able to do that in Delaware and not 

in other States? Why is that? Does it have anything to do with 

Medicaid expansion? 

Dr. HORTON. Yes, because that was the access. In order to put 

someone into treatment, I have to have a treatment to put them 

into, and that treatment is primarily the result of Medicaid expansion and programs like our largest program, Connections, developing those outpatient slots because they had revenue that could 

be relied upon. Without that revenue, the treatment system would 

not exist. 

We were able to leverage reachable moments. There are many 

more than just the hospital. So we are actually thinking about how 

do we partner with our colleagues or EMS and police to find those 

other reachable moments. The lockup, for example, is where an individual is so fearful going into that primal misery that they will 

agree to go into treatment. But you have to have those partnerships. You have to have that coordination. 

In the emergency room, when someone is being admitted to the 

hospital, they are there, and it really was more about having the 

institution accept that this was an issue and then moving forward 

to implement standardized care pathways. And, we are good at 

that. We are good at creating electronic health record mechanisms 

to screen and then algorithms to treat, and we had the wherewithal. So it was a natural place to do those approaches, and they 

worked, and they can now be replicated. By that, I mean identify 

individuals quickly around this issue of withdrawal, address the 

withdrawal aggressively and use that as the lever to move them 

into care. Most of the patients are very interested in it, and as I 

said, two-thirds of my patients are willing to go into treatment, and 

most of them show up at the back end. 

Our question really is, well, what about the lockup? Can we have 

the same sort of results where someone had been arrested, usually 

of petty crimes, breaking into a garage, such as I am told by our 

colleagues in New Castle County, the police departments are trying 

to struggle with this. They have actually come up with their own 

programs on their own called Hero Helps. 

Senator CARPER. Thank you for that. I would think of what Dr. 

Horton has described, a best practice and the ability to, when folks 

show up at a hospital and they are ready for treatment, we get 

them into treatment. Maybe each of you could give us one other 

quick example of a best practice that the rest of us could learn 

from and implement. Michael, do you want to go first? 

Mr. BOTTICELLI. Sure. Actually, this was an area that we focused 

on at the White House by bringing some good best practice. I will 

give you an example at Boston Medical Center. We opened what 

I believe is the first opioid urgent care center in the country. So, 

folks who either came in through the emergency department or 

were identified sometimes coming into the community could walk 
60 

in and we have dedicated staff, some peers, and recovery coaches 

who are able to work with them, to get a bed and access to care 

which is not easy, unfortunately. And so they work to make sure 

that people have the care that they need. 

But I have to say, because this is really important, Massachusetts I still believe has the lowest uninsured rate in the country. 

So it is not an issue for staff at Boston Medical Center in the emergency department or in any other facility. And we have a generous 

Medicaid benefit. 

Senator CARPER. OK. 

Mr. BOTTICELLI. So the opioid urgent care center I think is something that is worth looking at. 

Senator CARPER. Great. Thank you. Chief. 

Chief SYNAN. I would also have to go along the same track. In 

Hamilton County, we are trying to get the hospitals to work with 

us and allow those people to go in as patients. Again, we are looking at this from a law enforcement aspect, which is not going to 

solve the problem, or is not going to be the answer. 

But part of the problem we are also facing from the front-end 

line is also those people who do not want to get into treatment, 

which is a significant amount of people. So there is a hurdle not 

just going to jail or to the hospital, but how do we get them into 

those treatment facilities? If we had opiate centers, how would we 

get them there? So that is one of the challenges we are facing in 

Hamilton County that we are trying to overcome. If we could take 

them to a medical system where they could go to a hospital, start 

receiving medically assisted treatment, and if we started treating 

this like a brain injury or an illness, like it is defined, as a chronic 

illness, then I think we would have a better solution. 

Senator CARPER. Thank you, Chief. Dr. Gilson. 

Dr. GILSON. Thank you, Senator. A lot of ideas come to mind, 

and these guys—— 

Senator CARPER. Just give me one. Just give me one really good 

one. 

Dr. GILSON. I think one of the things that we have to do is use 

the information that can be gleaned from people who die of 

overdoses to design intervention strategies. We saw 40 percent of 

the people who came to my office during the heroin phase of this 

epidemic had been incarcerated within two years or they had been 

in treatment within two years. I send each of the people leaving 

jail or treatment facilities a letter spelling out risk reduction strategies: Do not use by yourself. Do not go back to the same dose. 

There is a tremendous amount of public health information to be 

gleaned by medical examiner systems, which, if we can take the 

burden off of the epidemic crushing these systems, could be potentially used to design very effective intervention strategies. 

Senator CARPER. All right. Good. Thank you for each of those, 

and I am going to close, but before I do, let me just add another 

thought or two and then turn it over to Senator Peters, and he will 

close it out. 

We want to thank you again for being here. For those with whom 

you work and represent, we thank them, too. Every now and then 

we have hearings that are illuminating. It is rare that we have a 

hearing that is both illuminating and terrifying, and this is really 
61 

both. And it really is, as I said at the beginning an ‘‘all hands on 

deck’’ moment. I am more convinced than ever as we wrap this up. 

When Bettina Tweardy Riveros was my deputy legal counsel in 

my last term as Governor, one of the things that I was asked to 

do is be the founding vice chairman of something called the American Legacy Foundation. The American Legacy Foundation was created out of the 50-State tobacco settlement where the tobacco industry provided a lot of money to each of the States for a period 

of 25 years, still does. They also provided about $1 billion or $2 billion to create something called the American Legacy Foundation, 

which developed a truth campaign, which was probably the most 

effective campaign we have seen in this country’s history in terms 

of convincing young people, if they were using tobacco, to stop, and 

if they had not started, not to start. 

I realize it is not an entirely comparable parallel here, but we 

have not talked at all about messaging. I think in the back of my 

mind messaging has got to be a part of all those other silver BBs— 

I talked about earlier. No silver bullet, but lot of silver BBs. One 

that I would not—given what we have accomplished with the 

American Legacy Foundation and the truth campaign, messaging 

is one I would not dismiss. 

Finally, I mentioned to the first panel and will say it to you as 

well. We will be asking questions for the record, and I will be asking for, again, a short list of things we ought to be doing, a sense 

of urgency, and ask you to come back with those ideas. You can repeat some of the things you said. That would be fine. But I think 

you could feel a real sense of urgency on this side of the dais, and 

I am sure we feel it from your side as well. Thank you all for what 

you are doing. We are in this together. Let us go forward together. 

God bless you. Thank you. Senator Peters. 

Senator PETERS. First, I want to concur with all your comments. 

Thank you, Senator Carper, for one final question. Going back to 

the root causes—and I appreciated your response on how we have 

to make sure we have health insurance and Medicaid available for 

substance abuse counseling and treatment. 

But there is also compelling evidence that prescription opioids 

are really one of the key drivers for what we are seeing here. Dr. 

Gilson, I know in your testimony it struck me that you mentioned 

in your county, of individuals who had been prescribed a controlled 

substance within two years of their death, over half of them had 

prescription opioids that led to this. 

And so, just in a final question: are we aware of other sorts of 

treatments that we should be prescribing so that we can stop what 

appears to be perhaps overprescription of opioids to patients who 

then become addicted to them, that we need to have different types 

of treatments, and thinking about how we practice medicine, and 

are there impediments to preventing that? What should we be 

thinking about going forward in trying to basically stop the pipeline that starts with some prescription drugs? 

Dr. GILSON. Thank you, Senator, for the question. I think that 

you have really hit the genesis of the problem, the nail on the head 

exactly. The culture in medicine tended toward overprescribing of 

opiate pain medications for chronic pain. The scientific support for 
62 

that was minimal, and that, unfortunately, became a standard of 

practice that I think has created a large opiate-addicted population. 

If we gave prescription pain medication to everyone in this room, 

they would become addicted to prescription pain medication. They 

would become addicted to opioids. We have created a substantial 

large addicted population through the use and abuse of prescription 

pain medication. That is absolutely, inconvertibly true. And how we 

get back from that I think is that we have to start the reeducation 

of our medical community. We have to put much stricter guidelines 

on people prescribing pain medication. 

I am sympathetic to people who have chronic pain, but if it is an 

effective treatment that creates an unnecessary and really detrimental consequence, that is not a good treatment, and we should 

hold accountable the people who promoted that idea. It was not 

very well documented, and I am really ashamed to say that the 

part that the medical community played in this crisis is not stopping. I still have lots of anecdotal information of people getting a 

month’s worth of Vicodin after they get teeth pulled, with refills. 

We have to stop that, turn that flow off. 

But I think Dr. Horton and other folks here said we have a population of people who already are suffering from that over-liberal 

prescription. We cannot turn our back on them. They are going to 

be with us for a while. And treatment does work, and I think the 

ways that we improve treatment will be more effective for that. 

Mr. BOTTICELLI. During my time at ONDCP, I think, we worked 

with the CDC on comprehensive guidelines. I think some of the 

issues that we heard in terms of non-opioid therapies, the challenges I think are changing the culture of just giving a prescription. But I think the other issues that we heard is insurance reimbursement for things like physical therapy and acupuncture, and 

often even mental health therapy that can really help. So that was 

an issue that we have really got to take a look at in terms of those 

challenges. 

I will say that we have had some good evidence in States that 

have really robust prescription drug monitoring programs. I think 

we have seen some good data on the reduction in prescription drug 

overdose deaths where physicians had to register and they had to 

check each and every time. And so I know many States have moved 

to mandatory registration and mandatory checks because it seems 

like that works. 

You often get pushback from physicians, and I understand that 

sometimes they are busy. But my response was we are 15 years 

into this epidemic and I do not think it is unreasonable for a physician to take a modicum of education and to check the prescription 

drug monitoring program. We are losing too many people. 

Senator PETERS. All right. Thank you. Thank you so much. I appreciate your testimony. 

Dr. Horton, I am sorry. Were you going to say something? 

Dr. HORTON. Only that in our State I think we have been able 

to implement some of those measures around the Prescription Monitoring Program (PMP), use of that, and really ratchet up regulations for prescribers. And it is a small State, so we are able to 

make these kind of changes, and we are starting to see that cultural change. So there is hope about being able to attend to it. 
63 

As far as treatment for prescription drugs, in many ways the 

genie is out of the bottle. Yes, most of the patients I attend to were 

exposed to prescription drugs, but now most of them are using heroin. We are actually starting to see—two epidemics. The prescription drug epidemic has not gone away, so those measures need to 

continue, reduce the exposure. But now we have a heroin epidemic 

as well. 

Mr. BOTTICELLI. If I could just add one more thing, because I 

think it is important. 

Senator PETERS. Please. 

Mr. BOTTICELLI. Because Congress supported this. If you talk to 

Dr. Nora Volkow and the folks at the National Institutes of Health 

(NIH), they will tell you that actually we need to do a better job 

at researching non-opioid pain medications. I think one of the barriers is looking at what the administration proposed in terms of 

NIH reductions. I think you really put a significant damper on 

NIH’s research capabilities and to come up with non-opioid, nonaddictive prescriptions for pain medication. I think it undercuts 

what Congress passed as part of the 21st Century Cures Act. 

Senator PETERS. Thank you so much. I appreciate it. 

Senator CARPER. Well, that is a good note to end on. We have 

a lot of good ideas. Some of them we have heard before. My preacher at our church likes to say—he knows he is preaching to the 

choir, but he says, ‘‘Even choirs need to be preached to.’’ So we appreciate you introducing to us a number of good practices, best 

practices, new ideas, but also some, especially the last one, that 

just make a whole lot of sense. 

Again, our thanks to all of you for coming, for the work that you 

and your colleagues are doing. The hearing record will remain open 

for 15 days for any additional comments or questions by any of our 

Subcommittee Members. And, with that, this hearing is adjourned. 

Thank you so much. 

[Whereupon, at 12:47 p.m., the Subcommittee was adjourned.] 

(65) 

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Æ