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EXAMINING THE GROWING PROBLEMS OF 

PRESCRIPTION DRUG AND HEROIN ABUSE: 

STATE AND LOCAL PERSPECTIVES 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESEN7TATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

MARCH 26, 2015 

Serial No. 114–27 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

LARRY BUCSHON, Indiana 

BILL FLORES, Texas 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

KEVIN CRAMER, North Dakota 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

DORIS O. MATSUI, California 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

PETER WELCH, Vermont 

BEN RAY LUJA ́ N, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

YVETTE D. CLARKE, New York 

DAVID LOEBSACK, Iowa 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TIM MURPHY, Pennsylvania 

Chairman 

DAVID B. MCKINLEY, West Virginia 

Vice Chairman 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

H. MORGAN GRIFFITH, Virginia 

LARRY BUCSHON, Indiana 

BILL FLORES, Texas 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

KEVIN CRAMER, North Dakota 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

JANICE D. SCHAKOWSKY, Illinois 

KATHY CASTOR, Florida 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

YVETTE D. CLARKE, New York 

JOSEPH P. KENNEDY, III, Massachusetts 

GENE GREEN, Texas 

PETER WELCH, Vermont 

FRANK PALLONE, JR., New Jersey (ex 

officio) 

(III) 

C O N T E N T S 

Page 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

Prepared statement .......................................................................................... 4 

Hon. Diana DeGette, a Representative in Congress from the state of Colorado, 

opening statement ................................................................................................ 6 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

opening statement ................................................................................................ 8 

Prepared statement .......................................................................................... 9 

Hon. Joseph P. Kennedy, III, a Representative in Congress from the Commonwealth of Massachusetts, opening statement .................................................... 10 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, prepared statement ........................................................................ 101 

WITNESSES

Fred Wells Brason, II, Executive Director, Project Lazarus, Moravian Falls, 

North Carolina ..................................................................................................... 12 

Prepared statement .......................................................................................... 15 

Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP, Associate Director 

of Pharmacy Practice, Gatton College of Pharmacy at East Tennessee State 

University, Johnson City, Tennessee, and Chair of the Board of Directors 

of Onecare of Southwest Virginia, Bristol, Virginia .......................................... 25 

Prepared statement .......................................................................................... 28 

Answers to submitted questions ...................................................................... 111 

Stefan R. Maxwell, M.D., Associate Professor, Pediatrics, WVU School of 

Medicine, MEDNAX Medical Group, Medical Director, NICU, Women and 

Children’s Hospital, Charleston, West Virginia ................................................ 38 

Prepared statement .......................................................................................... 40 

Answers to submitted questions ...................................................................... 115 

Rachelle Gardner, Chief Operating Officer, Hope Academy, Indianapolis, Indiana ......................................................................................................................... 49

Prepared statement .......................................................................................... 52 

Victor Fitz, Cass County, Michigan, Prosecutor, and President of the Prosecuting Attorneys Association of Michigan (PAAM), Cassopolis, Michigan .... 54 

Prepared statement .......................................................................................... 56 

Michael Griffin, Narcotics Unit Supervisor—K9 Handler, Special Investigations Division, Tulsa Police Department, Tulsa, Oklahoma ............................. 67 

Prepared statement .......................................................................................... 69 

Caleb Banta-Green, Senior Research Scientist, Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington ....................................... 80 

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

Answers to submitted questions ...................................................................... 119 

SUBMITTED MATERIAL

Majority memorandum ............................................................................................ 103 

Article entitled, ‘‘The New Heroin Epidemic,’’ in The Atlantic, October 30, 

2014, submitted by Mr. Tonko 1

U.S. Department of Justice announcement, submitted by Ms. DeGette 2

1 Available at: http://docs.house.gov/meetings/if/if02/20150326/103254/ 

hhrg-114-if02-20150326-sd008.pdf. 2 Available at:http://docs.house.gov/meetings/IF/IF02/20150326/103254/HHRG114-IF02-20150326-SD007.pdf 

(1) 

EXAMINING THE GROWING PROBLEMS OF 

PRESCRIPTION DRUG AND HEROIN ABUSE: 

STATE AND LOCAL PERSPECTIVES 

THURSDAY, MARCH 26, 2015 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:15 a.m., in room 

2123 of the Rayburn House Office Building, Hon. Tim Murphy 

(chairman of the subcommittee) presiding. 

Present: Representatives Murphy, McKinley, Griffith, Bucshon, 

Brooks, Mullin, Hudson, Collins, Upton (ex officio), DeGette, 

Schakowsky, Tonko, and Kennedy. 

Staff present: Sean Bonyun, Communications Director; Leighton 

Brown, Press Assistant; Noelle Clemente, Press Secretary; Brittany 

Havens, Legislative Clerk; Charles Ingebretson, Chief Counsel, 

Oversight and Investigations; Chris Santini, Policy Coordinator, 

Oversight and Investigations; Alan Slobodin, Deputy Chief Counsel, Oversight; Sam Spector, Counsel, Oversight; Jeff Carroll, 

Democratic Staff Director; Chris Knauer, Democratic Oversight 

Staff Director; Una Lee, Democratic Chief Oversight Counsel; Elizabeth Letter, Democratic Professional Staff Member; and Tim Robinson, Democratic Chief Counsel. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Mr. MURPHY. Good morning. 

As I call to order this Oversight and Investigations Subcommittee hearing to examine the growing problem of prescription 

drug and heroin abuse, allow me to share a few quotes from an article in the New York Times, citing the views of Dr. Hamilton 

Wright of Ohio. In the article, Dr. Wright is quoted as saying: ‘‘Of 

all the nations of the world, America consumes the most opium, in 

one form or another. The habit has this Nation in its grip to an 

astonishing extent. Our prisons and our hospitals are full of victims of it, it has robbed ten thousand business men and women of 

sense. The drug habit has spread throughout America until it 

threatens us with very serious disaster.’’ 

What is striking about these statements is not the dismal picture 

they paint, but rather, that these remarks were published over 100 

years ago in 1911. Back then, of course, we did not have the sciVerDate Nov 24 2008 13:12 Aug 23, 2016 Jkt 037690 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-27 CHRIS
2 

entific or government involvement that we have today. Back then, 

there was no National Office of Drug Control Policy—the ONDCP— 

and there was no Department of Health and Human Services, no 

Substance Abuse and Mental Health Services Administration, and 

there was no National Institute on Drug Abuse. Yet despite all of 

our science and public health agencies, and despite the billions of 

federal dollars devoted to fighting the opioid problem, the situation 

is no better than it was 100 year ago. Indeed, many would say the 

situation is far worse. 

According to the Centers for Disease Control, in just the past 3 

years alone, the number of heroin overdose deaths in the United 

States has tripled. Tripled. And in some parts of the country, such 

as the Midwest, heroin overdose death rates have increased over 

900 percent. Every day 120 people die from a drug overdose. The 

vast majority of these overdose deaths are due to prescription 

opioid medications. That is more than 43,000 deaths last year, or 

the tragic equivalent of one jetliner going down every single day. 

In 2009, an estimated 13,000 babies were born in the United 

States addicted to heroin or prescription opioids. That is about one 

opioid-addicted baby every hour of the day, every day of the week. 

Please note that this statistic is from 2009, several years before the 

CDC announced our country was in the midst of an overdose epidemic and before the current explosion of heroin overdose deaths. 

The number of babies born addicted to opioids is much worse 

today. I used to work in a newborn intensive care unit, and I have 

watched too many tiny infants go through withdrawal symptoms. 

But seeing only one is enough to break your heart. 

Something is desperately wrong with our Nation’s response to 

the opioid epidemic, and it is quite literally a matter of life and 

death that we get honest answers and not remain misguided in our 

approach to how we solve this crisis. 

Every Member of Congress is seeing the consequence of the federal government’s failure because it touches every community and 

every family across America. My own district in Pennsylvania has 

seen the terrible consequences of addiction and death from opiate 

overdoses, and the problem has only gotten worse over the past 

year. In Westmoreland County, Pennsylvania, the drug overdose 

death total for 2014 surpassed that of 2013—a record to that 

point—by an additional death, and during that time, the number 

of accidental deaths caused by heroin in the county increased by 

over 30 percent. In 2014, Allegheny County, where Pittsburgh is, 

had 281 fatal overdoses reported, compared to 278 the previous 

year, and it is climbing for this year. 

No federal agency has a more central role in this ongoing epidemic than the Department of Health and Human Services. HHS 

and its Substance Abuse and Mental Health Services Administration, otherwise known as SAMHSA, are tasked with leading our 

Nation’s public health response to opioid and heroin abuse and addiction. SAMHSA regulates our country’s 1,300 opioid maintenance—formerly known as methadone clinics—and is responsible 

for certifying the 26,000 physicians who prescribe the semi-synthetic opioid buprenorphine. According to testimony provided by 

SAMHSA before this subcommittee in April of last year, nearly 1.5 

million people were ‘‘treated’’—and I put ‘‘treated’’ in quotes—with 

3 

these opioids in 2012. That is a five-fold increase in the last 10 

years. Now, I might add, I will not call this treatment. It is addiction maintenance. 

Buprenorphine can more safely maintain a person’s dependence 

by reducing the need for illegal opioid abuse, such as heroin, and 

thereby the risk for overdose. But make no mistake, buprenorphine 

is a highly potent opioid, which according to SAMHSA, is 20 to 50 

times more potent than morphine. So it is worth considering that 

our national strategy to combat substance abuse is to maintain addiction by either prescribing or administering a heroin-replacement 

opioid. When you consider research from the National Institute on 

Drug Abuse documenting that almost everyone who stops taking 

buprenorphine relapses to illicit opioid use within a matter of 

weeks, it is deeply concerning thatwe don’t have the best solutions 

for addiction recovery. According to the Drug Enforcement Administration, when police conduct a prescription drug bust, the third 

most frequently seized drug by law enforcement is buprenorphine— 

more than methadone, more than morphine, more than codeine. 

And unlike clinics that administer methadone, there are no requirements for buprenorphine clinics to offer or even discuss nonaddictive treatment alternatives with patients, no requirements to 

develop treatment plans, no requirements to protect the public 

against it being diverted for illicit use. Meanwhile, the CDC reports 

that buprenorphine is the most frequently cited prescription drug 

in poisonings of children, accounting for nearly 30 percent of all 

opioid-related emergency department visits and 60 percent of emergent hospitalizations among children. 

Worse yet, of opioid-addicted babies who start their fragile lives 

being medically detoxified off of opioids, nearly half of their mothers are on buprenorphine or methadone maintenance in HHS/ 

SAMHSA-regulated or -certified practices. 

This is government-supported addiction. It is not moving people 

to sobriety. We should not just focus on the extraordinary costs of 

detoxifying babies off of buprenorphine, but also the profound consequences for these babies whose entire experience in the womb 

and after they are born is dominated by buprenorphine dependence. Further, there are significant concerns about short- and longterm neurodevelopmental impacts of opioid exposure in utero. Why 

is the government subsidizing this harm? 

Despite these problems, HHS and SAMHSA continue to actively 

and aggressively promote the use of buprenorphine, yet noticeably 

silent on promoting research and innovative measures with the 

goal of ending opioid addiction, not simply continuing addiction 

through drug maintenance programs of methadone. It concerns me 

that HHS and SAMHSA have no practical guidance on how to get 

people off of this prescribed opioid when those on buprenorphine 

maintenance for substance abuse disorders use illicit opioids an average of four times a week. 

Now, I recognize this morning that HHS announced new plans 

and funding to work on this issue, and this committee eagerly 

awaits to see the details on how that will play out. 

Compounding this crisis is the lack of evidence-based treatment 

to end opioid addiction, not merely replace an illicit drug with a 

government-sanctioned one. Evidence-based treatment includes deVerDate Nov 24 2008 13:12 Aug 23, 2016 Jkt 037690 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-27 CHRIS
4 

cisions based on scientific studies with quantitative data, and is 

distinguished from those relying on anecdotes and subjective observations. 

Only about 10 percent of persons with a substance abuse disorder will get any form of medical care. Of those who are lucky 

enough to get care, only 10 percent of them will get evidence-based 

treatment for the disease of addiction. Yet most medical professionals are not sufficiently trained to diagnose or treat the disease 

of addiction, and most providing addiction care are not medical professionals and are not equipped to provide the full range of effective treatments. 

Now, I believe in recovery. I believe in lives being restored and 

every individual living up to their full God-given potential and 

doing so drug-free. I desperately want our federal efforts to work 

in every community and for every family that seeks care for addiction disorders. And I know that working together, at the federal, 

State, and local level, we will achieve success. But we have to set 

our eyes on the goal of full recovery, not just addiction maintenance. We can do this, I have no doubt. 

We continue our oversight series today by listening to law enforcement and public health officials who are working at the on the 

front lines to protect our communities and our families in this national epidemic. We are grateful for your service and for taking the 

time to be with us today. 

[The prepared statement of Mr. Murphy follows:] 

PREPARED STATEMENT OF HON. TIM MURPHY

Good morning. As I call to order this Oversight & Investigations Subcommittee 

hearing to examine the growing problem of prescription drug and heroin abuse, 

allow me to share a few quotes from an article in the New York Times, citing the 

views of a Dr. Hamilton Wright, of Ohio. In the article, Dr. Wright is quoted as saying: ‘‘Of all the nations of the world, America consumes the most opium, in one form 

or another.’’ 

‘‘The habit has this Nation in its grip to an astonishing extent. Our prisons and 

our hospitals are full of victims of it, it has robbed ten thousand business men [and 

women] of sense ....’’ 

‘‘The drug habit has spread throughout America until it threatens us with very 

serious disaster.’’ What is striking about these statements is not the dismal picture 

they paint, but rather, that these remarks were published over 100 years ago in 

1911. 

Back then, of course, we did not have the scientific or government involvement 

that we have today. Back then, there was no National Office of Drug Control Policy 

(ONDCP); there was no Department of Health and Human Services (HHS), no Substance Abuse and Mental Health Services Administration (SAMHSA); and there was 

no National Institute on Drug Abuse (NIDA). Yet despite all of our science and public health agencies, and despite the billions of federal dollars devoted to fighting the 

opioid problem, the situation is no better than it was 100 year ago. Indeed, the situation is much worse. 

According to the Centers for Disease Control (CDC) in just the past three years 

alone, the number of heroin overdose deaths in the United States has tripled. And 

in some parts of the country, such as the Midwest, heroin overdose death rates have 

increased over 900 percent. 

Everyday 120 people die from a drug overdose. The vast majority of these overdose deaths are due to prescription opioid medications. That’s more than 43,000 

deaths last year, or the equivalent of one jetliner going down every single day. 

In 2009, an estimated 13,000 babies were born in the United States addicted to 

heroin or prescription opioids. That’s about one opioid-addicted baby every hour of 

the day, every day of the week. Please note that this statistic is from 2009, several 

years before the CDC announced our country was in the midst of an overdose epidemic and before the current explosion of heroin overdose deaths. The number of 

5 

babies born addicted to opioids is much worse today. I used to work on a newborn 

intensive care unit. I’ve watched too many tiny infants go through withdrawal 

symptoms. But seeing only one is enough is to break your heart. 

Something is desperately wrong with our nation’s response to the opioid epidemic, 

and it is quite literally a matter of life and death that we get honest answers and 

not remain misguided in our approach to how we solve this crisis. 

Every member of Congress is seeing the consequence of the federal government’s 

failure because it touches every community; every family across America. My own 

district has seen the terrible consequences of addiction and death from opiate 

overdoses, and the problem has only gotten worse over the past year. In Westmoreland County, Pennsylvania, the drug overdose death total for 2014 surpassed that 

of 2013—a record to that point—by one additional death. During the same time, the 

number of accidental deaths caused by heroin in the county increased by over 30 

percent. In 2014, Allegheny County had 281 fatal overdoses reported, compared to 

278 the previous year. 

No federal agency has a more central role in this ongoing epidemic than the Department of Health and Human Services. HHS and its Substance Abuse and Mental 

Health Services Administration (SAMHSA) are tasked with leading our nation’s 

public health response to opioid and heroin abuse and addiction. SAMHSA regulates 

our country’s 1,300 opioid maintenance (formerly known as methadone clinics), and 

is responsible for certifying the 26,000 physicians who prescribe the semi-synthetic 

opioid buprenorphine. According to testimony provided by SAMHSA before this Subcommittee in April of last year, nearly 1.5 million people were ‘‘treated’’ with these 

opioids in 2012. That is a 5-fold increase in the last ten years. I do not call this 

‘‘treatment.’’ It is addiction maintenance. 

Buprenorphine can more safely maintain a person’s dependence by reducing the 

need for illegal opioid use, such as heroin, and thereby the risk for overdose. But 

make no mistake, buprenorphine is a highly potent opioid, which according to 

SAMHSA, is ‘‘20–50 times more potent than morphine.’’ So it is worth considering 

that our national strategy to combat substance abuse is to maintain addiction by 

either prescribing or administering a heroin-replacement opioid. When you consider 

research from the National Institute on Drug Abuse documenting that almost everyone who stops taking buprenorphine relapses to illicit opioid use within a matter 

of weeks, it is deeply concerning we don’t have the best solutions for addiction recovery. 

According to the Drug Enforcement Administration, when police conduct a prescription drug bust, the 3rd most frequently seized drug by law enforcement is 

buprenorphine. More than methadone. More than morphine. More than codeine. 

And unlike clinics that administer methadone, there are no requirements for 

buprenorphine clinics to offer or even discuss non-addictive treatment alternatives 

with patients. No requirement to develop treatment plans. No requirements to protect the public against buprenorphine being diverted for illicit use. 

Meanwhile, the CDC reports that buprenorphine is the most frequently cited prescription drug in poisonings of children, accounting for nearly 30% of all opioid-related emergency department visits and 60% of emergent hospitalizations among 

children. 

Worse yet, of opioid-addicted babies who start their fragile lives being medically 

detoxified off of opioids, nearly half of their mothers are on buprenorphine or methadone maintenance in HHS/SAMHSA regulated or certified practices. This is government-supported addiction. It is not moving people to sobriety. We should not just 

focus on the extraordinary costs of detoxifying babies off of buprenorphine, but also, 

the profound consequences for these babies whose entire experience in the womb 

and after they are born is dominated by buprenorphine dependence. Further, there 

are significant concerns about short and long term neurodevelopmental impacts of 

opioid exposure in utero. Why is the government subsidizing this harm? 

Despite these problems, HHS and SAMHSA continue to actively and aggressively 

promote the use of buprenorphine, yet noticeably silent on promoting research and 

innovative measures with the goal of ending opioid addiction, not simply continuing 

addiction through drug maintenance programs of methadone or buprenorphine. It 

concerns me that HHS and SAMHSA have no practical guidance on how to get people off of this prescribed opioid when those on buprenorphine maintenance for substance abuse disorders use illicit opioids an average of four times a week. 

Compounding this crisis is the lack of evidence-based treatment to end opioid addiction, not merely replace an illicit drug with a government sanctioned one. Evidence-based treatment includes decisions based on scientific studies with quantitative data, and is distinguished from those relying on anecdotes and subjective 

observations. Only about 10 percent of persons with a substance abuse disorder will 

get any form of medical care; of those who are lucky enough to get care, only 10 

6 

percent of them will get evidence-based treatment for the disease of addiction. Yet, 

most medical professionals are not sufficiently trained to diagnose or treat the disease of addiction, and most providing addiction care are not medical professionals 

and are not equipped to provide the full range of effective treatments. 

I believe in recovery. I believe in lives being restored and every individual living 

up to their full God-given potential and doing so drug free. I desperately want our 

federal efforts to work in every community and for every family that seeks care for 

addiction disorders. And I know working that together, at the federal, state and 

local level, we will achieve success. But we have to set our eyes on the goal of full 

recovery, not just addiction maintenance. We can do this, I have no doubt. 

We continue our oversight series today by listening to law enforcement and public 

health officials who are working at the on the front lines to protect our communities 

and our families in this national epidemic. We are grateful for your service and for 

taking the time to be with us today. 

Mr. MURPHY. And with that, I now recognize Ms. DeGette of Colorado. 

OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Ms. DEGETTE. Thank you very much, Mr. Chairman, for convening this hearing today. 

As you noted, the opioid epidemic is nothing short of a public 

health crisis. In 2013, prescription painkillers were involved in over 

16,000 overdose deaths, and heroin was involved in an additional 

8,257 deaths. Over 2.1 million Americans live with a prescription 

opioid addiction while 467,000 Americans are addicted to heroin. 

These are devastating numbers, and they have been trending upwards for far too long. 

These numbers only paint a partial picture of the heavy toll of 

the epidemic in our society. Throughout this country, countless 

families and communities have been shattered by opioid abuse, 

misuse and addiction. It is time that we really truly pursue best 

practices supported by scientific research that will reverse this 

problem. 

Recent advances in science have shown us that addiction is a disease of the brain. This demands that we approach the problem not 

only as a public safety issue but also as a public health issue. Yes, 

we must stop drug smugglers and crack down on pill mills, but we 

also must work with prescribers to educate them and prevent the 

over-prescription of opioids for pain management. And most importantly, we must improve our ability to identify and treat people 

with substance abuse disorders. 

In 2013, for example, only 1 in 10 Americans with a substance 

abuse disorder received any form of treatment. That is just unacceptable, and we should be asking why so few Americans are accessing the treatment they need. 

Research indicates that medication-assisted treatment, or MAT, 

combined with counseling is the most effective way to treat opioid 

addiction. Studies further demonstrate that MAT reduces the risk 

of drug overdoses, infectious disease transmission, and engagement 

in criminal activities. 

Despite this track record, in 2013, MATs were available in only 

9 percent of substance abuse treatment facilities nationwide. Even 

more troubling are reports that some treatment facilities that 

adopt an abstinence-based approach to drug treatment do not allow 

7 

patients to take MATs while enrolled in their programs. According 

to experts, a high percentage of opioid addicts in abstinence-based 

treatment return to opioid abuse within 1 year, and as you said, 

Mr. Chairman, even within a few weeks. Given the limited success 

of these programs in promoting long-term recovery in opioid addicts, we must ask some hard questions regarding how we should 

be spending our limited resources for treatment. 

Finally, we know that patients with substance abuse disorders 

continue to face significant barriers to treatment. For example, 

right now there is a nationwide shortage of qualified substance 

abuse providers, particularly people who can prescribe MATs. Recent press reports also suggest that patients face long waiting lists 

for admission into treatment facilities, and according to the American Society of Addiction Medicine, both State Medicaid programs 

and private insurers have policies in place that are limiting patients’ access to MATs. We need to better understand these barriers and what we can do at the federal level to address them. 

There are some reasons for optimism, however. First, the Affordable Care Act has expanded access to substance abuse treatment 

for millions of Americans. Insurance companies are now required 

to provide coverage of treatment for substance abuse disorders just 

as they would for any chronic disease. These policies represent the 

largest extension of treatment access in a generation, and hopefully 

they will guide millions into successful recovery. 

Second, we do have some sense of what works. Some of our witnesses today who have firsthand knowledge on what strategies are 

effective to treat and prevent substance abuse will talk about that. 

They know what has worked in their communities, and we need to 

have them help us inform the national discussion. 

I do want to thank our witnesses today, Mr. Chairman. We have 

asked all of you to attend this hearing because of the important 

work that you are doing to raise drug awareness, break down the 

stigmas long associated with substance abuse disorders, and put 

people on the path to recovery. 

Finally, Mr. Chairman, your continued oversight on this issue 

gives me reason to be optimistic that this committee can play a role 

in turning the tide. You have indicated your intention to conduct 

a series of hearings on this topic, and I am certainly glad to be 

your partner in this inquiry. 

To that end, I suggest that our next hearing focus on state responses to the epidemic. There is significant variation from state 

to state on treatment quality, access and coverage. Some states are 

making progress but some are not, and we should hear the best 

practices. We also need to hear from federal agencies on these 

same topics. 

This committee has an opportunity to make a meaningful difference in addressing the problem, and I am welcoming all of our 

joint efforts. 

And with that, Mr. Chairman, I just want to let the witnesses 

know, this committee has a bill on the floor right now, so I have 

to run down and make a statement on the floor. I am leaving us 

in the capable hands of Mr. Kennedy, and I will be back after my 

statement. Thank you. 

8 

Mr. MURPHY. I thank the gentlelady, and thank you for your 

comments—very pointed. 

I now recognize the chairman of the full committee, Mr. Upton, 

for 5 minutes. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Well, thank you, Mr. Chairman. 

Today we continue our important review of the growing epidemic 

of prescription drug and heroin abuse. The state and local perspective of this growing threat is essential as we evaluate what steps 

we can take at the federal level to help address the crisis. 

Sadly, communities all across the country have been affected by 

prescription drug and heroin abuse, including my district in southwest Michigan. Devastatingly, heroin overdoses sadly are on the 

rise due to a combination of high demand and purity that can 

make the drug even more lethal. There were 13 suspected 

overdoses in Kalamazoo in the first quarter of 2013, compared to 

nine in the quarter before that in the earlier year. This unwelcome 

trend is unfortunately all too familiar as opiate-related overdoses 

have recently become the number one cause of death in Michigan 

and nationwide, surpassing motor vehicle crashes, suicide, firearms, and homicide. 

I know personally a number of families that have been shattered 

by that overdose. The reality of heroin overdoses has hit hard in 

Kalamazoo County the last few years. In 2008, we lost a beautiful 

little girl named Amy Bousfield, 18 years old. In 2012, Marissa 

King died at 21. She began using heroin in 2009, despite having 

lost two friends to the drug. Marissa had an underlying mental illness. She was diagnosed with bipolar disorder, had struggled with 

depression, and had abused prescription drugs before turning to 

heroin after graduating from a local high school. These are just a 

few of the heartbreaking stories that we see all across the country. 

We are losing about 20,000 people a year from abuse of prescription pain killers or heroin. 

As we continue to mourn the loss of all these lives, testimony 

from you all today will provide us an effective approach making a 

real difference in fighting this awful abuse. This is a great opportunity for this committee, on a bipartisan basis, to help improve 

the federal government’s response to this epidemic. I am especially 

pleased to welcome one of today’s witnesses, my good friend Vic 

Fitz, the Cass County Prosecutor and the President of the Prosecuting Attorneys Association of Michigan. He has 31 years of experience in prosecuting drug cases, and will certainly share his insights today as he has done with me over the past number of years 

and with other fellow prosecutors in Michigan on this issue. I 

would note that the heroin dealer who sold the heroin that killed 

Amy Bousfield was caught, convicted, and sentenced to 10 1⁄2 to 40 

years in prison. We appreciate the work of Vic and his fellow prosecutors who have held dealers accountable to the law, and helped 

addicts straighten out their lives. I thank him and all of you for 

your service, and for participating at today’s hearing, and I yield 

the balance of my time to Mr. McKinley. 

[The prepared statement of Mr. Upton follows:] 

9 

PREPARED STATEMENT OF HON. FRED UPTON

Today we continue our important review of the growing epidemic of prescription 

drug and heroin abuse. The state and local perspective of this growing threat is essential as we evaluate what steps we can take at the federal level to help address 

this crisis. 

Sadly, communities all across the country have been affected by prescription drug 

and heroin abuse, including southwestern Michigan. Devastatingly, heroin overdoses 

are on the rise due to a combination of high demand and purity that can make this 

drug more lethal. There were 13 suspected overdoses in Kalamazoo in the first quarter of 2013, compared to 9 in the first quarter of 2012. 

This unwelcome trend is unfortunately all too familiar as opiate-related overdoses 

have recently become the No.1 cause of death in Michigan and nationwide, surpassing motor vehicle crashes, suicide, firearms, and homicide. 

The reality of heroin overdoses has hit hard in Kalamazoo County the last few 

years. In 2008, we lost Amy Bousfield, 18 years old and a graduate of Portage Central High School. In 2012, Marissa King died at 21 years old. She began using heroin in 2009, despite having lost two friends to the drug, including Amy Bousfield. 

Like 40 percent of those who abuse drugs, Marissa had an underlying mental illness. She was diagnosed with bipolar disorder, had struggled with depression, and 

had abused prescription drugs before turning to heroin after graduating from Comstock High School. 

There are many heart-breaking stories like this across the country. We are losing 

about 20,000 people a year from abuse of prescription pain killers or heroin. As we 

continue to mourn the loss of all these lives, testimony from today’s witnesses provides us hope that there are effective approaches making a real difference in fighting opioid abuse. This is a great opportunity for this committee, working on a bipartisan basis, to help improve the federal government’s response to this epidemic. 

I am especially pleased to welcome one of today’s witnesses, my friend Vic Fitz, 

the Cass County Prosecutor and the President of the Prosecuting Attorneys Association of Michigan. Vic has 31 years of experience in prosecuting drug cases, and will 

share his insights as well as those of his fellow prosecutors in Michigan on this 

issue. I would note that the heroin dealer who sold the heroin that killed Amy 

Bousfield was caught, convicted, and sentenced to 10 and a half to 40 years in prison. We appreciate the work of Vic and his fellow prosecutors who have held dealers 

accountable to the law, and helped addicts straighten out their lives. I thank him 

for his service, and for participating at today’s hearing. 

Mr. MCKINLEY. Thank you, Mr. Chairman, and thank you, Mr. 

Murphy, for holding this hearing today focusing on this growing 

epidemic. Thank you to the witnesses for coming here to testify. 

Prescription drug and heroin abuse has steadily increased. You 

have heard it throughout the comments that have been made here 

and throughout our country, and I have seen it firsthand in my 

home State of West Virginia. Currently, West Virginia is suffering 

from the highest rate of drug overdose mortality rates in the entire 

country. 

Since coming to Congress in 2010, our office has been working 

on solutions. We have had roundtable meetings throughout the district with law enforcement, healthcare professionals, educators, and 

community leaders about how to address this problem. What we 

have heard is at least three solutions. One is, we need to be focused 

better on education; secondly, on proactive prevention; and thirdly, 

resources for our law enforcement to take these drug traffickers off 

our streets. Therefore, by expanding the High Incident Drug Traffic 

Area—HIDTA—in West Virginia, it has provided an incredibly effective tool for catching drug offenders and taking them off the 

streets. This is just one option. I hope to learn more from the rest 

of this panel today. 

Thank you, and I yield back my time. 

10 

Mr. MURPHY. Thank you. The gentleman yield back. I now recognize Mr. Kennedy of Massachusetts for 5 minutes. 

OPENING STATEMENT OF HON. JOSEPH P. KENNEDY, III, A 

REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS 

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

to all the witnesses that are here today who have dedicated so 

much of their time, efforts, energy, and lives to confronting this crisis, either through treatment, community health or through law enforcement. We are grateful for your commitment and all you do to 

try to address this problem head-on, and I want to thank the chairman of the committee and of the subcommittee as well for calling 

an important hearing. 

There are few people in this country that have been spared the 

heartbreaking impact of watching a loved one, a neighbor, a friend, 

a colleague fall victim to opiate addiction. It is an epidemic striking 

red states and blue states, small towns and big cities, neighborhoods rich and poor. The breadth and depth of this epidemic is 

truly staggering, and there is no silver bullet. But perhaps there 

is a silver lining, which you have heard already this morning. It 

translates into strong bipartisan consensus here in Washington 

that we have to do something about it. 

Back home in the 4th District of Massachusetts, there is not an 

event that I go to where this topic does not come up. Communities 

like Fall River in Taunton have been particularly hard-hit. Local 

leaders are working tirelessly to respond. 

Across the Commonwealth, we confront a growing epidemic. In 

2013, there were 978 opioid-related deaths in Massachusetts, according to the Department of Public Health, which has yet to release 2014 figures. In fiscal year 2014, there were more than 

104,000 admissions to State-contracted substance abuse treatment 

programs in Massachusetts, more than 53 percent of which were 

for heroin addiction. 

Despite these numbers, I repeatedly hear from providers in my 

district that there is a profound lack of resources for the prevention 

and treatment of substance abuse, especially when it comes to 

opioid addiction. Insufficient wraparound services, low reimbursement rates, and bureaucratic barriers to treatment harm patients 

and undermine our efforts to reverse addiction trends. 

According to CPAC, the New England Comparative Effectiveness 

Public Advisory Council, 133,000 people in New England abuse or 

are addicted to opiates. Of those, 70 percent meet the criteria for 

treatment but cannot access it. We know that this is a problem 

with no silver bullet solution. We are working to chip away at it, 

and I am proud to have joined Representative Whitfield this morning in reintroducing legislation to reauthorize the NASPER program, the National All Schedules Prescription Electronic Reporting 

program. The program is designed to provide grants to states for 

the establishment, implementation, and improvement of prescription drug monitoring programs. We know that timely access to patient records and high standards of interoperability are successful 

with PDMPs, and this legislation will give providers the tools that 

they need to identify and treat at-risk behavior. 

11 

To those of you who are here today to testify, you are on the 

frontlines of this epidemic. You are fighting every single day for 

our communities, our neighborhoods and our backyards. This gives 

you unparalleled insight into what works and to what doesn’t. We 

are here today to learn from you, to take the lessons that you have 

learned from your cities and towns, and try to transport them 

across the entire country. 

Let me just say I first became aware of the scope of this addiction and the scope of this problem as a prosecutor in local communities in Massachusetts, finding young men and women that were 

breaking into 15 cars in a night, five, six homes over the course of 

the weekend, undercover agents that were putting themselves at 

great risk to try to keep our communities safe. So for those of you 

in law enforcement that are here, I look forward to hearing your 

ideas. From those folks back home that I have talked to, they have 

profound recognition that we will not arrest our way out of this 

problem, but very much look forward to hearing your solutions as 

to what we can do going forward, and I yield back my time. 

Mr. MURPHY. I thank the gentleman for yielding your time. You 

are all done on your side? All right. Thank you. 

What we are going to do is, I am going to swear in the witnesses 

and then I am going to ask members who invited witnesses to introduce each one of you briefly, and hopefully we will get your testimony done before votes because we do want to hear from you and 

ask questions. 

So you are all aware that the committee is holding an investigative hearing, and when doing so has the practice of taking testimony under oath. Do any of you have any objections to giving testimony under oath? Seeing no objections, the chair then advises you 

that under the rules of the House and the rules of the committee, 

you are entitled to be advised by counsel. Do any of you desire to 

be advised by counsel during your testimony today? No one indicates they want counsel, so in that case, if you would all please rise 

and raise your right hand, I will swear you in. 

[Witnesses sworn.] 

Mr. MURPHY. You may sit down. All the witnesses have indicated 

in the affirmative. You are under oath and subject to the penalties 

set forth in Title XVIII, Section 1001 of the United States Code. 

We will call upon you each to give a 5-minute summary of your 

written testimony. We will start off with Mr. Fred Wells Brason, 

and Mr. Hudson of North Carolina will introduce the witness. 

Mr. HUDSON. Thank you, Mr. Chairman. 

I am pleased today to introduce Fred Wells Brason, a former hospice chaplain, now President and CEO of Project Lazarus from my 

home State of North Carolina. Mr. Brason has had tremendous 

success in saving lives from opioid overdoses, and I look forward to 

hearing his testimony and learning from his great work. 

Mr. MURPHY. Mr. Brason, you are recognized—is it Brason or 

Branson? 

Mr. BRASON. Brason. 

Mr. MURPHY. Mr. Brason, you are recognized for 5 minutes. Turn 

the mike on, pull it close to you, watch the red light. That will tell 

you when you are done. Thank you. 

12 

STATEMENT OF FRED WELLS BRASON, II, EXECUTIVE DIRECTOR, PROJECT LAZARUS, MORAVIAN FALLS, NORTH CAROLINA; DR. SARAH T. MELTON, PHARMD, BCPP, BCACP, CGP, 

FASCP, ASSOCIATE DIRECTOR OF PHARMACY PRACTICE, 

GATTON COLLEGE OF PHARMACY AT EAST TENNESSEE 

STATE UNIVERSITY, JOHNSON CITY, TENNESSEE, AND 

CHAIR OF THE BOARD OF DIRECTORS OF ONECARE OF 

SOUTHWEST VIRGINIA, BRISTOL, VIRGINIA; STEFAN R. MAXWELL, M.D., ASSOCIATE PROFESSOR, PEDIATRICS, WVU 

SCHOOL OF MEDICINE, MEDNAX MEDICAL GROUP, MEDICAL 

DIRECTOR, NICU, WOMEN AND CHILDREN’S HOSPITAL, 

CHARLESTON, WEST VIRGINIA; RACHELLE GARDNER, CHIEF 

OPERATING OFFICER, HOPE ACADEMY, INDIANAPOLIS, INDIANA; VICTOR FITZ, CASS COUNTY, MICHIGAN, PROSECUTOR, 

AND PRESIDENT OF THE PROSECUTING ATTORNEYS ASSOCIATION OF MICHIGAN (PAAM), CASSOPOLIS, MICHIGAN; 

CORPORAL MICHAEL GRIFFIN, NARCOTICS UNIT SUPERVISOR—K9 HANDLER, SPECIAL INVESTIGATIONS DIVISION, 

TULSA POLICE DEPARTMENT, TULSA, OKLAHOMA; AND DR. 

CALEB BANTA–GREEN, SENIOR RESEARCH SCIENTIST, ALCOHOL AND DRUG ABUSE INSTITUTE, UNIVERSITY OF 

WASHINGTON, SEATTLE, WASHINGTON 

STATEMENT OF FRED WELLS BRASON, II 

Mr. BRASON. Thank you very much. Chairman Murphy, thank 

you for convening this and giving us the opportunity to share what 

is happening on the streets of our communities and our response 

to the issues that we encounter, and I am talking back to 2004 as 

a hospice chaplain realizing the medication issues that were happening in our community homes where families were stealing, 

sharing, and selling the medication of and with the patients. 

Having addressed it that way and not having any solutions, we 

in Wilkes County, North Carolina addressed it from a public health 

perspective: this is our house, our community, and we need to fix 

it. And by doing that, we convened all the community sectors that 

we could, and working with each single one to derive a solutionbased process from our schools to our law enforcement to our medical community to our prescribers, and in doing that, we created a 

public health model to sort of bring awareness to the issue but then 

also making sure that there is a balanced approached so that we 

are talking about prevention, intervention, and treatment across 

the spectrum. We do want to prevent the overdoses from occurring 

but we also want to ensure that patients can have access to care, 

receive the medication and the treatment that they are entitled to 

but receive it safely and appropriately, but then those individuals 

who do have and have developed a substance use disorder, disease 

of addiction and so forth, that they have a safety net so that they 

are not just pushed into the heroin or they are not pushed someplace else. 

A community has to address all of those facets, and we began by 

addressing first community awareness and community education so 

that individuals receiving a prescription can take it correctly, store 

it securely, dispose of it properly, and never share. Unfortunately, 

those are common practices that go on in our community with the 

13 

right prescription for the right person but when it is in the home, 

the family is feeling like, well, it is OK because the doctor wrote 

it. Those are some of the public health reversals that we need to 

do. Then we work with our prescribing community to, you know, 

look at how to best manage chronic pain, how to manage acute 

pain, how to appropriately prescribe but then also how to assess 

patients, how to determine they are at risk, you know, possibilities, 

but then also looking within the community, and if there is a risk 

of something already has developed, who can I have the warm 

handoff to for the treatment that is necessary to them, whether it 

is an abstinence program, whether it is a medication-assisted treatment, whether it is a methadone or a buprenorphine or naltrexone. 

There isn’t one treatment that works for everybody but there is 

treatment that works for everybody, so we have to make sure our 

communities have accessibility for all of that, and that is what we 

look for in our community and we are able to do that by education. 

When I first mentioned methadone, I thought I was leaving 

North Carolina permanently. It was not a pleasant time. But after 

education and understanding of what treatment is and how the 

brain is affected when somebody has been using for a while, there 

has to be a stabilization. There has to be a bridge, and we have 

to be able to provide that to those who are in trouble. 

But then as we address the prescribing community, then we also 

had to talk to our law enforcement, work with them on diversion 

techniques, the take-back programs, the permanent drop-offs for 

old meds in the home because in 2012, we did dispense 259 million 

prescriptions, which means we have accidental ingestion going on, 

especially among toddlers. So we have patients misusing, unfortunately overdosing. We have toddlers’ accidental ingestion, unfortunately overdosing. We have families and friends sharing with unfortunate overdosing. We have recreational users going out for a 

good time and somebody having a pill for them dying from an overdose, and then we have those with substance use disorder dying 

from an overdose. Looking at all of those categories within our population groups, we have to address all population groups, all ages 

from a public health perspective to reverse the behaviors, the misconceptions, and the problems that arise from that but ensuring 

that those that need it can receive it, those that need treatment 

can receive it and have it. 

So as we did that, then we looked at, you know, what treatments 

could we bring into the community, and then we introduced 

naloxone. The North Carolina Medical Board was the first medical 

board in the country to come forth with a position statement that 

best practice is supporting and having an available naloxone, especially co-prescribing that with a medication to those individuals 

who are at risk. A person at risk could just be released from jail 

or person. A person at risk could be receiving methadone for treatment or for pain. A person at risk could be receiving opioid medication for their pain or they have a previous history for substance 

use. So, there is a broad base for the naloxone. It just needs to be 

made available, and thankfully, out of the State of Virginia, they 

are putting forth a law that sort of mandates co-prescribing of 

naloxone to a person receiving extended release or long-acting 

opioid medication. It is a safety factor. It is not a treatment but it 

14 

is a rescue medication, and many of our communities now, especially Massachusetts, North Carolina and others, law enforcement 

are saving lives, and that is what is important to them. So it is a 

safety factor to do that. 

But without a comprehensive approach, there is not any one single bullet, there is not any one single thing. It has to be everything 

and it has to be all of us in order to drive the change from a public 

health perspective and have best practice from the individual to 

the prescribers, to the emergency departments, and everybody in 

between to accomplish that. 

Thank you for your time. 

[The prepared statement of Mr. Brason follows:] 

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Mr. MURPHY. Thank you very much. 

Now we are going to recognize Dr. Sarah Melton, and Mr. Griffith of Virginia is going to introduce you. 

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

I am glad to introduce Dr. Sarah Melton. Dr. Melton chairs 

OneCare of Southwest Virginia, a consortium of substance abuse 

coalitions attempting to turn the tide against substance abuse. She 

is an Associate Professor of Pharmacy at ETSU and most recently 

was appointed by Governor Terry McAuliffe to the Virginia Task 

Force on Prescription Drug and Heroin Abuse, an idea first proposed to the Governor by myself and others in the Virginia Congressional Delegation. 

Dr. Melton has a long history of working to address the substance abuse problems in southwest Virginia. She was instrumental in bringing Project Lazarus to Virginia, and she is also 

working on the naloxone issues in southwest Virginia and in Virginia. I want to thank you, Dr. Melton, for being here today and 

sharing your experience with our committee. 

Mr. MURPHY. Dr. Melton, you are recognized for 5 minutes. 

STATEMENT OF SARAH T. MELTON 

Ms. MELTON. Thank you, Mr. Chairman, and thank you, Congressman Griffith and the other members of the subcommittee. 

During my testimony, I am going to address key areas related to 

state and local initiatives that are making an impact, and I will 

also address key areas where I feel the federal government can assist in these areas. 

The first key area I will address is education of prescribers. As 

you are all aware, students and residents in healthcare professions 

have limited exposure to curricula in identifying and treating substance use disorders and appropriate prescribing and dispensing of 

controlled substances for chronic pain, but in Virginia, we are 

working together to bring leaders from all healthcare schools together to assure that our prescribers and dispensers of controlled 

substances have received an adequate education on addiction and 

the treatment of chronic pain. 

Overall, more funding is needed form the federal level to provide 

expanded graduate medical education opportunities for training in 

the identification, referral, and treatment of substance use disorders. As changes in federal funding allocated for graduate medical education are currently being discussed, it is an opportune 

time to assess how funding can best address training in addiction 

medicine. 

Tennessee has a mandated annual continuing education requirement for prescribers. Virginia, however, does not have that. 

OneCare of Southwest Virginia has joined with the Medical Society 

of Virginia and the Virginia Department of Health to provide nocost continuing medical education to all healthcare prescribers as 

well as dispensers. We have been able to educate over 2,000 prescribers and dispensers in the past 3 years. We are currently evaluating how that continuing education has changed prescribing habits, attitudes, and registration to the prescription drug monitoring 

program as well as other outcomes. 

26 

I wanted you to know that in January, a letter was sent directly 

from Secretary of Health and Human Services, Dr. Bill Hazel, to 

all prescribers in Virginia. The letter specifically addressed new 

legislation that requires prescribers to be monitored, to be registered in the prescription drug monitoring program, but it also 

talked about how to use the PMP programs in clinical practice. I 

am happy to report as a result of that letter, the prescription drug 

monitoring program registrations dramatically increased, and we 

are seeing a steady increase in inquiries to the PMP in the clinical 

setting. We are going to be sending a letter to all pharmacists in 

the Commonwealth in the next month. 

With regard to access to naloxone, both Virginia and Tennessee 

have recently passed legislation that will provide wide access to 

this lifesaving medication, and OneCare has worked extensively 

with the Virginia Department of Behavioral Health and Developmental Services to train people across the Commonwealth through 

Project Revive. Last summer, Senator Tim Kaine attended one of 

those trainings in Lebanon, Virginia, and as a result of his training, he has introduced legislation through the Opioid Overdose Reduction Act to offer Good Samaritan protection for first responders. 

It is my hope that Congress will pass this legislation so that we 

have a consistent Good Samaritan protection across the Nation. 

One barrier we are finding with naloxone, though, is the cost. It 

is not mandated by insurance companies to cover this medication, 

and it really should be. 

With regard to treatment, medication-assisted treatments with 

methadone, buprenorphine, and naltrexone have become an essential component of a comprehensive treatment plan for opioid use 

disorders. The issue that we have now is that we need a modernization of federal law to further expand access to these lifesaving medications but we need specific best practice requirements 

and recommendations for prescribers and insurers such as Medicaid and Medicare to make sure that certain patients are receiving 

comprehensive care by competently trained healthcare providers. 

Also critical is reimbursement for parts of these programs such as 

urine drug screens and the necessary psychotherapy that accompanies the medication treatment. 

With regard to monitoring with the prescription drug monitoring 

program, both Virginia and Tennessee are members of the National 

Association of Boards of Pharmacy Interconnect program, and I am 

very happy to find that the bill that will find NASPER is being proposed because the funding for that allocation will help all States 

be able to participate in a national prescription drug monitoring 

program. There is one concern I have, though. You may or may not 

know, a concern that we encounter daily in clinical practice is that 

methadone clinics are not required to report methadone dispensing 

to the prescription drug monitoring programs. This is a very serious situation because if these patients do not disclose this to their 

primary care providers and they don’t know it when they access 

the prescription drug monitoring program, we often see other 

opioids being prescribed, benzodiazepines that can lead to death. So 

that is an issue of concern. And in contrast, buprenorphine, of 

course, is reported to the State prescription drug monitoring proVerDate Nov 24 2008 13:12 Aug 23, 2016 Jkt 037690 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-27 CHRIS
27 

grams that allow us more monitoring for safety and appropriate 

use. 

Thank you for the opportunity to testify and for your ongoing 

commitment to this epidemic across the United States. 

[The prepared statement of Ms. Melton follows:] 

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Mr. MURPHY. Thank you. 

Now I am going to recognize the vice chair of the subcommittee, 

Mr. McKinley, to introduce Dr. Maxwell. 

Mr. MCKINLEY. Thank you, Mr. Chairman. 

Dr. Stefan Maxwell is a neonatalist in Charleston, West Virginia, 

caring for the sickest of the newborns for the past 30 years. He is 

Chairman of the West Virginia Perinatal Partnership, which focuses on reducing the number of babies born who are exposed to 

drugs. A study in this topic in 2009 revealed that 20 percent, one 

in five, babies born in West Virginia were exposed to a substance 

during the pregnancy. 

Dr. Maxwell’s work in the Perinatal Partnership in West Virginia has led to great strides in finding ways to identify women in 

need of drug treatment counseling and reduce the number of babies 

born exposed to drugs. His leadership as Chairman of the Perinatal 

Partnership and the Committee on Substance Abuse in Pregnancy, 

a member of the West Virginia Governor’s Advisory Council on 

Substance Abuse, and caring for sick babies at Charleston Area 

Medical Center has made him a leading expert on this topic. 

Thank you, Dr. Maxwell, for attending here today and providing 

us your experiences. 

Mr. MURPHY. Doctor, you are recognized for 5 minutes. 

STATEMENT OF STEFAN R. MAXWELL 

Dr. MAXWELL. Thank you Congressman McKinley and thank you, 

Mr. Chairman for the opportunity. It is pretty humbling to be 

asked to speak with such an august group, but hopefully this testimony will help us in your quest to quell this rising tide that is a 

scourge in our Nation. 

I have had the opportunity to take care of these babies that are 

suffering from neonatal abstinence syndrome, and so at the time 

back in 2006 when the West Virginia Perinatal Partnership was established, their mission was to look at areas that we could improve 

the health of mothers and babies in West Virginia, and at the time 

when all of the providers got together in a room, we decided that 

substance abuse in pregnancy or substance usage in pregnancy was 

an issue that we had to address, mainly because at the time, these 

babies that had neonatal abstinence syndrome were taking up most 

of the beds in the ICU, and level III institutions could not accept 

sick, small, premature babies from outlying institutions. Some of 

them had to be transported out of the State. 

So at the time, we really were not understanding the whole impact of what was happening in the State. So I missed a meeting 

and became chairman of the substance abuse committee, I have to 

say, and I was given that responsibility, and over the ensuing 3 

years or so, we tried to figure out what was the prevalence of this 

problem in our State, and so we embarked upon the umbilical cord 

tissue study, which looked at eight hospitals through the State, 

scattered throughout the State. We collected as many umbilical 

cord tissue samples as we could as sort of a pilot over a month-long 

period. We ended up collecting almost 800 samples, and then we 

realized that one in five of those samples was positive for a substance, many of them being polydrug abusers, which included opiates, marijuana, and so forth. 

39 

So this was obviously a daunting problem, and so at the 

Perinatal Partnership we decided to try to be proactive rather than 

reactive, and by that, I mean we wanted to see if we could reduce 

the numbers of babies with neonatal abstinence or at least reduce 

the severity of the neonatal abstinence syndrome at the end of the 

pregnancy. So we embarked upon a project that we called the 

Drug-Free Mothers and Babies Project whereby we sent out requests for proposals, got four or five in, and now have established 

four or five programs that are in the process. The aspects of this 

project are, one, we screen all women at the first antenatal visit, 

whether we do it using biological specimens like urine or we do it 

with screening tools such as what we call SBIRT screening, brief 

intervention, referral, and treatment. And then once we have identified a woman, a pregnant woman, who is using an opiate specifically, we then refer them to an addiction counselor and behavioral 

medicine, and try to follow them throughout that pregnancy with 

a goal to reducing or first of all converting the substance they are 

using to another drug that we can probably wean throughout the 

pregnancy with a goal to reducing the amount of drug that the 

baby is exposed to during the pregnancy and ultimately get them 

either off the drug or on a very small dose so that the severity of 

neonatal abstinence would be that much reduced. 

Well, one of those programs has been operating now for about 2 

years, and we have had great success with one of those programs, 

reducing their incidence of 19 percent of positive umbilical cord tissue samples at birth to 8 percent, which means that the cost associated with neonatal abstinence has been significantly reduced. We 

have also been following these ladies who have been in the program for up to a year. We don’t have 2 years’ worth of follow-up 

yet, but the goal is to follow them at home for the first 2 years 

after delivery and reinforce that behavioral modification that went 

on throughout the pregnancy. 

The ultimate goal if this is a successful program is to develop 

what we call a pay-for-success program, whereby we can now try 

to save the government money in the long run by having an investor fund these programs, have an independent entity such as the 

Partnership administer the program with an independent audit, 

and at the end hopefully show that we have reduced the cost and 

ultimately improved the lives of these people that are ravaged by 

this terrible disease. 

Thank you for the opportunity, Mr. Chairman. 

[The prepared statement of Dr. Maxwell follows:] 

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Mr. MURPHY. Thank you. 

Now we are going to go to Ms. Brooks to introduce her guest here 

today. 

Mrs. BROOKS. Thank you, Mr. Chairman. 

Rachelle Gardner is here today representing the Hope Academy 

in Indianapolis, Indiana, in my district. Rachelle is the Chief Operating Officer and one of the founders of Hope Academy, a tuitionfree Indiana public charter high school for students in recovery 

from drug and alcohol addiction. 

As 80 percent of students relapse from recovery upon returning 

to their own high school, Hope Academy is essential in combating 

the staggering statistic. Hope Academy is the only recovery high 

school in Indiana and one of only 35 within the United States. 

Rachelle also serves as the Director of Adolescent Services at Fairbanks Drug and Alcohol Treatment Center, and she is the Board 

Chair for the Association of Recovery Hospitals. And so I want to 

welcome Ms. Gardner and the other panelists today. 

Mr. MURPHY. Thank you. 

You are recognized for 5 minutes. Thank you. 

STATEMENT OF RACHELLE GARDNER 

Ms. GARDNER. Thank you, Mr. Chairman and Congresswoman 

Brooks and members of the committee for allowing me to speak to 

you today. My name is Rachelle Gardner, and I have the privilege 

of serving as the Director of Adolescent Services for Fairbanks, an 

addiction treatment provider, and the Chief Operating Officer of 

Hope Academy, a recovery high school, both located in Indianapolis, Indiana. 

Hope Academy is the only recovery high school in Indiana and 

one of 35 recovery schools in the United States. For the last 4 

years, I have served as the Chair of Board of Directors for the Association of Recovery Schools, also known as ARS, and the purpose 

of ARS is to support and inspire recovery schools around the country. My entire career has been dedicated to working with youth 

who are struggling with substance abuse. 

The abuse of opiates continues to rise in central Indiana. According to the Indiana University Center for Health Policy, the number 

of adolescents receiving treatment for opiate dependence has risen 

9 percent over the last 5 years. One of the most staggering statistics is that since 1999, the number of opiate-related deaths has 

quadrupled in Indiana. Over the last 18 months, Fairbanks has admitted 360 young people ages 15 to 23 who indicated opiates as 

their primary drug of choice. 

Heroin holds a firm grip on its victims and the withdrawal experience from this drug is extremely painful and challenging to overcome. Another danger of heroin is the significant potential for a 

fatal overdose. According to the Indiana State Department of 

Health, in 2011 there were 63 heroin-related deaths in Indiana and 

in 2013 that number increased to 152. 

All of the programs and services at Fairbanks for adults and adolescents are driven by our mission to focus on recovery. Recovery 

from alcohol and drug addiction is challenging for anyone, but especially for our young people who have yet to develop the coping 

skills necessary to work a successful recovery program. 

50 

In the United States, 80 percent of students relapse from recovery upon returning to their high school following primary treatment for substance abuse. Fairbanks was seeing this same trend 

and in response, opened Hope Academy in 2006. Hope Academy is 

a public charter school sponsored by the Mayor of Indianapolis. We 

serve students in grades 9 through 12 who are seeking a safe, 

sober, and supportive environment. We are committed to small 

class sizes with highly qualified teachers who are well trained to 

educate and support students in recovery from drug and alcohol addiction. Most of our students struggle with co-occurring behavioral 

and mental health issues as well, yet because of the expertise of 

our staff, we are able to address these issues. 

The key to a successful recovery program is changing the people, 

places, and things in your life. Sending a child back to their former 

school puts them in the environment that may have led to their 

drug and alcohol use. Hope Academy provides these students with 

an environment that contributes to academic success, personal 

growth, and life-long recovery. Our students’ success is measured 

in growth. We define growth in many ways: the number of days 

they remain abstinent from drugs and alcohol, their ability to obtain credits and graduate, repairing relationships with families and 

friends, and developing much-needed life skills. 

Over the last 9 years we have served more than 500 students at 

Hope Academy. Some of these students felt strong enough in their 

recovery to successfully transition back to their home schools and 

graduate. Yet over 100 students chose to stay and are now alumni 

of Hope Academy. Many have pursued postsecondary education or 

advanced vocational training with the goal of joining the workforce 

and contributing positively to their communities. 

Academic achievement and recovery success are our primary 

goals at Hope Academy. We have partnered with Indiana Wesleyan 

University’s Addictions Counseling Program to produce a Web site 

for the purpose of sharing research outcomes with other recovery 

schools around the country. One recent study produced data that 

strongly suggests students attending Hope Academy were overall 

persistent in their education, which in turn reduced their behavioral and mental health issues while increasing the strength of 

their recoveries. 

Through my work with the Association of Recovery Schools, I 

have become quite familiar with the national advocacy efforts surrounding the Comprehensive Addiction and Recovery Act of 2015, 

or CARA. Last year, Senator Whitehouse of Rhode Island and Senator Portman of Ohio submitted this critical piece of federal legislation. If passed, this would authorize increased funding for treatment, recovery, and criminal justice systems while aiming to reduce opioid misuse and overdose deaths. In section 303 of CARA, 

the National Youth Recovery Initiative is of special importance to 

the various organizations I represent because of the attention it 

pays to adolescent treatment and recovery resources. Each of you 

can help us get the resources needed to make a lasting impact on 

the opiate crisis at a national level by first empowering our local 

communities. This passage of legislation is critical to helping our 

youth, our families and our communities who are fighting this epidemic on a daily basis. 

51 

The disease of addiction has permeated our society for hundreds 

of years. In my 25 years of experience, I have never, ever seen a 

class of drugs take hold of young people like I have with opiates. 

They are highly addictive and too often lead to premature death, 

which unfortunately I have seen way too many times. Opiates are 

claiming the lives of our country’s future leaders. 

My hope in testifying today is that together we can not only provide young people the access to treatment and recovery supports 

they need but also to restore their hope for a positive future. 

Thank you for the opportunity to be here today and I look forward to answering any of your questions. 

[The prepared statement of Ms. Gardner follows:] 

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Mr. MURPHY. Thank you, Ms. Gardner. 

Now, Mr. Fitz, I will recognize you. You are the prosecutor of 

Cass County, Michigan, also the President of the Prosecuting Attorneys Association of Michigan. Welcome here. You are recognized 

for 5 minutes. 

STATEMENT OF VICTOR FITZ 

Mr. FITZ. Chairman Murphy and esteemed members of the Oversight and Investigations Subcommittee, as indicated, my name is 

Victor Fitz and I am the prosecutor in Cass County, Michigan. 

Cass County is a medium-sized county in lower Michigan abutting 

South Bend on the Indiana border. We are equidistant from Chicago and Detroit, 2 hours to the west of Chicago, 2 hours to the 

east is Detroit. I want to thank you for the opportunity to be here 

today both on behalf of the Cass County Prosecutor’s Office as well 

as the Prosecuting Attorneys Association of Michigan, particularly 

to address this very serious and horrifying epidemic that we are 

facing in Michigan as well as the Nation as a whole. 

Michigan, like the rest of our States, is extremely diverse from 

county to county, but we are all similar in one way, Michigan from 

our Upper Peninsula to the shores of Lake Superior right down to 

our urban areas of Detroit, Saginaw, Muskegon, Flint and the like, 

and that is that we are dealing with the devastating problem of 

prescription drug abuse and heroin abuse. It is devastating all of 

our communities. It is not just an inner city problem. It is not just 

a rural problem. It is there and everywhere in between. 

All people are vulnerable to abusing these drugs because they 

are so very addictive. This abuse can start innocently, for instance, 

a teenager who becomes addicted to OxyContin after a serious athletic injury or someone perhaps recreationally who starts using less 

addictive drugs and graduates their drug use to heroin. It takes 

only one time to become addicted to heroin, and that one time is 

ruining futures, it is ruining families, and it is ruining lives. 

The opiates found in prescription pills are the addictive ingredient in heroin, and that is why users of prescription drugs eventually seem to turn to heroin. It is also simple economics. As we have 

found in Michigan as well as other parts of the Nation, it is actually cheaper to use heroin than prescription drugs on many occasions. We found in Michigan that heroin is actually cheaper in 

many areas than even marijuana. It can be smoked, it can be 

snorted, and it can be injected. It is quick and it is easy. 

Statistics in the State of Michigan indicate that in the year 2001, 

there were 271 heroin overdose deaths in our State—I am sorry. 

That would have been the year 2001 and 2002, a 2-year period. 

Fast-forward to 2011. That number quadrupled. For one year, the 

year 2011 had 728 heroin deaths. 

I know the congressional representative from Colorado spoke earlier about the 8,000 heroin deaths in the United States, and allow 

me just for a moment to personalize that from a prosecutor’s perspective, from a law enforcement perspective. We had about 2 years 

ago in Cass County and Bering County in southwest Michigan, our 

two counties, we had a heroin death that occurred, or suspected 

heroin death. In Michigan we now have a law that indicates that 

if you deliver heroin or any drug and that causes the death of that 

55 

person, it is the equivalent of a second-degree murder charge. Unfortunately, because of the newness of this statute, law enforcement not having protocols, did not seize upon the opportunity to investigate in that fashion initially. So as the investigation did take 

forward once my office became aware of it by the exhumation of the 

body, which I can tell you was something that was quite traumatic 

to the victims of the teen who had been killed from suspected drug 

activity. While that investigation was going on, in an effort to show 

that the death came from the use of heroin and other drugs that 

were supplied, this individual was still out on bond and he again 

delivered to another person, who also died from a heroin overdose. 

I can tell you that the pain and the agony is palpable for the victims and for those families. 

On Monday of this week, I was talking to another family of a 

homicide situation, didn’t happen to be drugs, but I can tell you 

when it is a violent death, when it is a death from a drug overdose, 

the pain never leaves the family. Again, these are real. The number 8,000, as mentioned earlier, every one of those is a tragedy for 

the family and for the community and for the friends. 

We are also seeing pre-teenagers abusing prescription drugs and 

heroin. It is a terrifying tragedy. Anything that we can do to battle 

this epidemic needs to be done. The Michigan Department of Community Mental Health in my State has developed a work group to 

design a strategic plan to combat this type of drug abuse. The plan, 

which is in place through the year 2015 through September 30, 

2015, generally recommends the following: increasing multisystem 

collaboration across agencies, broadening statewide media messages, increasing training for physicians regarding drug abuse for 

education in schools, and increased access to databases regarding 

controlled substances for health professionals and law enforcement. 

In my written testimony, I provide some other potential options in 

that regard. Anything we can do to combine strategies and improve 

operations to get our citizens help and to put an end to what is deteriorating lives should be done. 

If I could have just one moment, I want to mention very briefly 

our prosecutor from Wayne County in the Detroit area. Kim Worthy asked me this morning to just pass on a couple things very 

quickly that again this is not just a rural issue, it is also an urban 

issue, and they have excessive pill mills, violent crime, robbing of 

pharmaceutical vehicles going through their neighborhoods, murders occurring from these situations, and she again emphasizes we 

need to attack it on both the supply and the demand end. 

Thank you very much. 

[The prepared statement of Mr. Fitz follows:] 

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Mr. MURPHY. Thank you very much. 

Now Corporal Mike Griffin will be introduced by Mr. Mullin of 

Oklahoma. 

Mr. MULLIN. Thank you, Mr. Chairman. 

It is a very great privilege I have to introduce not just Corporal 

Mike Griffin but a friend of mine. Mike and I used to meet just 

about every Friday morning to have breakfast, and in his words, 

he says just to help me stay grounded. 

Mike has worked with the Tulsa Police Department for 17 years 

and spent 12 of those years in an undercover capacity conducting 

drug investigations. For the past 10 years, he’s been a supervisor 

within the department’s narcotics unit. Previously, Corporal Griffin 

was with a special agent with the Bureau of Alcohol, Tobacco, and 

Firearms. He has also served as a member of the Oklahoma Army 

National Guard. Mike, thank you for being here today. 

Mr. MURPHY. You are recognized for 5 minutes. 

STATEMENT OF MICHAEL GRIFFIN 

Mr. GRIFFIN. Chairman Murphy, Ranking Member DeGette, and 

members of the committee, on behalf of Chief Chuck Jordan and 

the Tulsa Police Department, thank you for the opportunity to discuss prescription opioid abuse, heroin abuse, and heroin trafficking. 

Although heroin abuse and trafficking in Tulsa lags far behind 

the abuse and tracking of methamphetamine, heroin is trafficked 

into Tulsa in the same manner as methamphetamine and cocaine, 

and its abuse leads to similar related criminal activity ranging 

from petty larceny to armed robbery and even murder. 

Narcotics investigators within the Tulsa Police Department know 

that a large majority of individuals currently addicted to heroin 

began their drug abuse by abusing prescription drugs. The Tulsa 

Police Department currently has 751 sworn police officers. TPD believes the focus of drug investigations should be on those individuals who are responsible for trafficking drugs into and through our 

community rather than on those individuals who are merely addicted to drugs. This is because of our belief that resources are best 

utilized at the source of the problem rather than on the symptoms 

of a problem. With that goal in mind, of the 751 sworn officers 

working for TPD, one investigator is assigned to investigate prescription drug cases within the city. Our lone prescription drug investigator spent the last 20 years investigating prescription drug 

cases. He believes that Oklahoma has one of the best prescription 

monitoring programs in the United States. Oklahoma’s PMP is real 

time and allows doctors and pharmacists to quickly access an individual’s prescription drug history to evaluate if they are possibly 

doctor-shopping to gain access to prescription drugs. 

If a person gets addicted to opioids, it is not long before they realize that obtaining prescription drugs are harder to access due to 

Oklahoma’s PMP and more expensive than heroin. Because these 

individuals already are addicted to opioids, the transition to heroin 

is easier and cheaper. 

Heroin trafficking in Tulsa is operated by Mexican drug trafficking organizations. Similar to other drug investigations conducted at the local or state level, the individuals most often arrested and prosecuted are the local dealers and operation leaders. 

68 

However, the individual profiting most from the illegal distribution 

of heroin resides in Mexico and is usually beyond prosecution at 

the state level. 

Additionally, and still consistent with other drug investigations, 

when the individuals at the local or state level are arrested, Mexican DTO simply replaces those individuals with other low-level 

people within the organization. Therefore, the drug-trafficking organization is able to continue distributing drugs within a community almost uninterrupted. 

Data confirms that drug abuse not only provides a demand for 

drugs to be trafficked into and throughout the United States but 

also that drug abuse and distribution leads to other crimes occurring in a community. An approach targeting drug trafficking without taking into account a need to prevent drugs from even entering 

the United States is shortsighted. Prior efforts by law enforcement 

agencies and state legislators to prevent drug crimes and crimes 

that occur because of drug dependence and distribution have shown 

to be successful. For example, reducing the availability of 

pseudoephedrine has shown to reduce the number of meth labs operating in Oklahoma and other States with similar legislation. This 

legislation has not only reduced the number of meth labs operating 

within a state but is also shown to significantly lower associated 

criminal activity. According to the FBI, no other country in the 

world has a greater impact on the drug situation in the United 

States than does Mexico. The FBI states that each of the four 

major drugs of abuse are either produced in or transported through 

Mexico before reaching the United States. 

Mexican drug-trafficking organizations use numerous methods to 

smuggle drugs into our country to include aircraft, horses and 

mules, tunnels, vehicles, and even people walking across the border. Data provided by the DEA shows that the supply of heroin 

coming from Mexico has increased over the past 5 years and that 

part of the increase in heroin seizures may be due to the decrease 

in U.S. demand for Mexican marijuana, which has led Mexican 

drug farmers to increasingly plant opium poppies in lieu of marijuana. 

It is clear that prescription opioid abuse and the related heroin 

abuse are issues that affect communities across the United States. 

Without a comprehensive approach to these issues, many people 

across the county will continue to be affected by these drugs. 

The Tulsa Police Department recommends a continuation of the 

comprehensive approach to drug trafficking currently in place, 

which relies on coordination among law enforcement agencies, community-oriented policing, intelligence and information sharing, and 

improved technology. The Tulsa Police Department also encourages 

additional federal efforts be made to prevent drugs of all kinds 

from crossing our international borders and finding their way into 

communities across the United States. 

[The prepared statement of Mr. Griffin follows:] 

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Mr. MURPHY. Thank you, Corporal. I appreciate your testimony. 

Last but not least is Dr. Banta-Green, Senior Research Scientist 

at the Alcohol and Drug Abuse Institute at the University of Washington in Seattle. 

Doctor, you may now give a 5-minute summary of your written 

statement. 

STATEMENT OF CALEB BANTA-GREEN 

Mr. BANTA-GREEN. Good morning, Chairman Murphy and members of the committee. I am honored to speak to you today about 

how we can improve the health of our communities as they struggle with how to manage stress, pain, and addiction in a society and 

a healthcare system that has historically valued and incentivized 

quick fixes over real health and wellness. We face big challenges 

but we do know what needs to be done. 

I am a Senior Research scientist at the Alcohol and Drug Abuse 

Institute at the University of Washington, where I am also Affiliate 

Faculty in the School of Public Health and the Harborview Injury 

Prevention and Research Center. My current work includes leading 

a study of an intervention to prevent opioid overdoses among heroin and pharmaceutical opioid users that is funded by the National 

Institutes of Health. I have a project analyzing prescription monitoring program data and developing interventions with those data 

to improve health for those taking controlled substances. This is 

funded by the Bureau of Justice Assistance with an award to our 

State Department of Health; and I am currently running the Center for Opioid Safety Education which supports communities across 

Washington State so that they can respond to the overwhelming 

impacts of opioid abuse and overdose in their communities. That 

funding is from the SAMHSA block grant to our state substance 

abuse agency. 

As a public health researcher, I think in terms of primary prevention—preventing a problem from starting; secondary prevention—intervening in a problem to prevent it from getting worse; 

and tertiary prevention—to prevent death and serious harm. 

Given that our communities are in crisis, let us start with preventing death and serious harm. Overdoses can be prevented and 

most can be reversed before they become fatal if people know how 

to recognize an overdose and how to respond. Overdoses are a crisis 

of breathing. 911 needs to be called. An antidote, naloxone, needs 

to be administered, rescue breathing needs to be initiated and the 

overdose victim needs to be monitored. Naloxone is a proven, safe 

medication yet far too few people who need it even know about it, 

can get it easily or can afford it. Overdose education on naloxone 

can be provided in a doctor’s office, by a pharmacist, at jails or via 

community-based health education programs such as syringe exchanges. Those at highest risk for overdose are heroin users. Syringe exchanges have the staffing expertise and trusting relationships with our loved ones who use heroin that are necessary to provide lifesaving services. 

At the same time, far more people are using pharmaceutical 

opioids. About 3 percent of adults use opioids chronically for pain. 

They also need overdose education and take-home naloxone. 

81 

Fatal overdose prevention is a necessary first step, but it is a 

short-term emergency response. Given that opioid addiction leads 

to changes in the brain and that addiction is a chronic and relapsing condition, it needs to be treated as a chronic medical condition. 

We are fortunate to have medications to support opioid addiction 

recovery. Methadone and buprenorphine have been consistently 

shown in research to save lives and be cost efficient. However, access is still limited by regulatory, geographic, and financial barriers. 

Switching to those using opioids for chronic pain, realistic expectations about pain relief need to be discussed, including the fact 

that long-term opioid use may not lead to good pain control and in 

fact may reduce functioning. Washington State has led the nation 

by implementing chronic pain management guidelines in 2007 

which have subsequently been codified in State law. Key points of 

these guidelines include: a dosing threshold trigger for consultation 

with a pain specialist; patient evaluation elements; periodic review 

of a patient’s course of treatment; encouraging prescriber education 

on the safe and effective uses of opioids; and the use of medicationassisted treatment if a person is not successfully tapered off of 

opioids and has an opioid use disorder. 

So, how do we prevent opioid addiction in the first place? Given 

that the majority of young adult heroin users now report they were 

first hooked on pharmaceutical opioids, it is clear that addressing 

inappropriate initiation is essential. The decision to begin prescribing opioids for minor injuries and pain needs to be carefully 

considered as does the total quantity dispensed if they are prescribed. Opioids in the home need to be carefully monitored and 

immediately disposed of when no longer needed. Parents need to 

know how to talk with their kids about medication safety as well 

as how to manage stress and pain without medications, drugs, or 

alcohol. 

To conclude, we can keep people alive, we can treat harms related to opioid use and we can prevent misuse, but, given the potential harms of improper care for those with opioid use problems, 

we need to take a strategic approach based upon the fact that 

pharmaceutical opioids can be used interchangeably with heroin 

and we need to work on prevention and intervention simultaneously. 

Thank you very much. 

[The prepared statement of Mr. Banta-Green follows:] 

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Mr. MURPHY. I thank the entire panel. We will try and get 

through as many questions of members as possible, and we will 

have votes, but we will continue on because one vote will be brief. 

So Dr. Melton, let me start off with you. What is the goal of 

medication to deal with opioid addiction? Is it to keep the addict 

maintained for life or is the goal to have it part of a program of 

getting the person clean and sober from the drugs? 

Ms. MELTON. That is a great question and a point of controversy 

in the clinical setting. Of course, to me the goal of medication-assisted treatment is to provide a treatment for the patient where 

they are able to do the hard work and become productive members 

of society. And so the way I think of it as a patient who has addiction has constant craving and constant thoughts of where am I 

going to get my next opioid. When they are prescribed methadone 

or buprenorphine, the craving is relieved and they are able to focus 

their efforts on doing the really hard work that is necessary, and 

that is the psychotherapy, group, 12-step programs, et cetera. So 

the overall goal is for the patients to receive the treatment for a 

limited period of time. We usually tend to think of it as 2 years, 

1 year for them to become stable and do the hard work and perhaps a year to taper off of it. However, there are some patients 

that are wanting to have this maintenance for life. We know we 

have seen that in some patients, but the goal is eventually for 

them to be productive members of society and not to be maintained 

long-term. 

Mr. MURPHY. I am looking at a study here that was in the New 

England Journal of Medicine by Johnson, et al, and it reports that 

patients on buprenorphine used illicit opioids an average of four 

times per week. So I don’t know how much that is working. Can 

you comment on that? 

Ms. MELTON. Well, what I would say with that and I address in 

my testimony is that we are in dire need of more regulations and 

recommendations on evidence-based care of how these programs 

should be run. We know in Tennessee and southwest Virginia some 

buprenorphine programs have become pill mills where the physicians charge them high prices, they come in and get their medication, and they leave. 

Mr. MURPHY. So there is an incentive, are there incentives because there are cash transactions in many cases and what you describe, they become pill mills? Is that what it has become? 

Ms. MELTON. Yes. We are seeing that, and it is devastating in 

many circumstances. There is a dearth of access to good treatment, 

and by ‘‘good treatment,’’ I mean patients being seen frequently, 

getting urine drug screens at nearly every visit, if not every visit, 

requiring 12-step programs, group counseling, and not co-prescribing with other drugs of addiction such as benzodiazepines. 

Mr. MURPHY. Because otherwise with the government funding 

these things, we are just in that great term that we use, the clinical terms, we are codependents, we are enablers if we create these 

incentives. 

I move on to another—Dr. Brason, your experience with Project 

Lazarus, what has been the most effective approaches in getting 

addicts completely off drugs? 

Mr. BRASON. Getting patients off—— 

86 

Mr. MURPHY. Yes, off drugs. 

Mr. BRASON. A comprehensive approach and determining and assessing that individual of what the best treatment modality may 

be. Some can walk right into a 12-step abstinence program. Others 

who have been using for even longer then do need that maintenance therapy in order to give them that stability so that you can 

work on their entire life. Now, somebody who is getting the methadone or the buprenorphine can receive that, and that takes 

maybe—if they are getting daily dosed—an hour and a half a day. 

What happens to the other 22, 23 hours of that person’s life when 

they had gone from 24/7 of looking to use, getting to use and figuring out where they are going to obtain that? It takes community 

support. You have got to have the life systems around that individual so that if they are getting the right maintenance therapy or 

the right 12 steps, they have got the counseling, they have all of 

those in place, but what happens when they go home? You talk 

about a rural community. They leave their house or they go to 

detox and they leave detox during the same home, same environment, same friends. If there is no other support around that to help 

them stay strong in that environment, then they fall back into the 

same situation. 

Mr. MURPHY. So somewhere out there in America, we hope someone is watching this hearing that themselves is dealing with drug 

addiction. If you had a chance to look them in the eye and say 

something to that addict, what do you say? 

Mr. BRASON. My word to them would be: We are here, I am here 

to help you, and let us walk through this together to see what best 

works for you so that we can then work on all the circumstances, 

situations, and issues that brought you to that place. We can talk 

about the drug problem, but what caused all of that? 

Mr. MURPHY. And in simple words too, Ms. Gardner, is there 

hope? Can you give someone hope that they can get off drugs? 

Ms. GARDNER. Well, we have talked a lot about the disease and 

the negative effects and the horrible things that happen with this 

disease, but there is hope. There are lots of people across this country staying clean and sober, have multiple years. I get the pleasure 

of working with young people, watching them graduate, watching 

them go on to postsecondary education, watching them become productive members of the communities. 

I work with lots of young people around the country who have 

gone through similar situations through high school and collegiate 

recovery that are doing great things. There is a lot of hope. I agree 

with the panelists. We are all saying the same thing. It is a comprehensive approach to this between medications, between law enforcement, between schools, between educating doctors. There is 

hope. 

Mr. MURPHY. Thank you. 

Ms. GARDNER. And we need to focus on the hope. 

Mr. MURPHY. Thank you. 

I am out of time, and I will recognize Ms. DeGette for 5 minutes. 

Ms. DEGETTE. Thank you very much, Mr. Chairman. 

Dr. Banta-Green, I was very interested in your testimony that 

when somebody becomes addicted to opiates, there are actually 

changes in their brain. Is that right? And I am assuming, Dr. 

87 

Melton, you would agree with that as well from your testimony. 

You need to answer. 

Ms. MELTON. I agree, yes. 

Ms. DEGETTE. Thank you. And so Dr. Banta-Green, I think this 

is why you are saying that somebody who is addicted to opiates, 

the best treatment is not just to have counseling or a 12-step program for most patients; they also need to have something to sort 

of rejigger their brain. Is that right? That is not a scientific term, 

by the way. 

Mr. BANTA-GREEN. Rejigger? I am not familiar with that one, but 

I know what you mean. So I think that is right. I think what we 

need, as Mr. Brason said, is we need a range of options. 

Ms. DEGETTE. Right. 

Mr. BANTA-GREEN. We need a menu of things. Different things 

work for different people. 

Ms. DEGETTE. And would you agree with that, Dr. Melton? 

Ms. MELTON. I also agree, yes. 

Ms. DEGETTE. And so what we have learned is, and we have 

been referring to this, there was a recent article that said that abstinence-based treatment only works in about 10 percent of opiate 

addicts. Would you agree with that, Dr. Banta-Green? 

Mr. BANTA-GREEN. I am not sure it is exactly 10 percent. What 

I—— 

Ms. DEGETTE. But it is a low percentage, right? 

Mr. BANTA-GREEN. It is a minority. I think it is important—Dr. 

Roger Weiss at Harvard had a paper come out last month that followed up after 42 months people who had started on 

buprenorphine. Some did well at the front end. Some did not. After 

42 months, only 8 percent were still addicted to opioids but about 

a third of those people had managed to not be on medication-assisted treatment but many had still been on medication-assisted 

treatment. 

Ms. DEGETTE. OK. 

Mr. BANTA-GREEN. There are different paths for different people. 

Ms. DEGETTE. Yes, but the best protocol would be for these folks 

to have the option to have the medication-assisted treatment, the 

MAT, plus the counseling that Dr. Melton talked about? 

Mr. BANTA-GREEN. Absolutely. There is no question about that. 

Ms. DEGETTE. And were you aware that the MAT treatment was 

only available in about 9 percent of all substance abuse treatment 

facilities nationwide? 

Mr. BANTA-GREEN. I know that it is a very low proportion. 

Ms. DEGETTE. And Dr. Melton, were you aware of that too? 

Ms. MELTON. Yes. 

Ms. DEGETTE. OK. And Mr. Brason? 

Mr. BRASON. Yes. 

Ms. DEGETTE. Now, Dr. Melton, you probably see this in your 

practice. One of the biggest problems that we have with the lack 

of the MAT treatment is in rural areas. Is that true in the areas 

where you practice? 

Ms. MELTON. That is correct. 

Ms. DEGETTE. And Mr. Brason, you are nodding your head. Are 

you seeing that too? 

Mr. BRASON. That is correct also, yes. 

88 

Ms. DEGETTE. Now, I am hearing from folks—and you know, for 

those of us who are concerned about over-prescription of opiates, 

who are concerned about young people getting addicted to heroin 

and other opiates, the idea of substituting one for another like with 

methadone or other drugs, that sort of goes against our instincts, 

but in fact, I guess I will ask this question: Is the use of those 

medications simply replacing one addiction with another, Dr. 

Banta-Green? 

Mr. BANTA-GREEN. No. A person who is being managed on medication-assisted treatment, per the Diagnostic and Statistical Manual, the American Psychiatric Association, it is not addicted anymore. They are physiologically dependent on opioids. We need to 

separate out addiction from dependence. Addiction is what we see, 

all the social and psychological pieces plus the physical. You address the physical and then you can deal with the rest. 

Ms. DEGETTE. And Dr. Melton talked about how if you can get 

folks into adequate treatment with the MATs, then with the counseling, she said the goal would be sort of a 2-year process. One is 

to get them to be stabilized and thinking, and the other one is to 

get them off. Would you agree with that type of thought? 

Mr. BANTA-GREEN. No. 

Ms. DEGETTE. OK. 

Mr. BANTA-GREEN. I would say that the goal is for the person to 

do well, and for some of them, that is going to be to go off the medications immediately. They are not going to do well on those medications. For other people, they are going to have a short period. For 

people who have been involved in addiction and a lot of their life 

has been wrapped around it for 10, 15, 20 years, that is going to 

take a long time to work through and it is going to take a longtime 

for them to recreate that life. So some people may need to be on 

them long term, some not at all, some short term. 

Ms. DEGETTE. So Dr. Melton, what would you say about my 

question about is the use of these medications simply replacing one 

addiction for another? 

Ms. MELTON. Absolutely not. I agree with him. It is not addiction. We are getting them into a state of where those behaviors 

that meet the criteria for addiction are gone. They are now in a 

state of physiologic dependence on the opioid, but because of that 

dependence, they are able to do the hard work that we have discussed, and I totally agree when I said the 2-year, when you look 

at insurance companies, they limit buprenorphine a lot of times to 

2 years. 

Ms. DEGETTE. OK. 

Ms. MELTON. But for some people, it will be a lifetime, as I said. 

Ms. DEGETTE. And for some people, they don’t even need the 

MATs, right? 

Ms. MELTON. Some people are able to do abstinence. 

Ms. DEGETTE. And you agree with that too, Mr. Brason? 

Mr. BRASON. Yes, I do. 

Ms. DEGETTE. Thank you very much, Mr. Chairman. 

Mr. MURPHY. Thank you, Ms. DeGette. I now recognize Mr. 

McKinley for 5 minutes. 

Mr. MCKINLEY. Thank you again, Mr. Chairman. 

89 

Two things, and if I could direct those to Dr. Maxwell. You said 

something that I found very intriguing in your remarks and also 

in your testimony, and that was about pay for success, and I spent 

a little time, I was looking—I did a little research, the beauty of 

Google, to be able to read that, and I understand that program may 

be working across the country. Can you give us a little bit more 

information about, one, the program of pay for success, and two, 

this proactive role that you talked about for drug-free moms and 

babies? I am curious about it because what I am hearing from you 

is that you have actually got programs to solve this, and so I am 

curious to see, or at least address it. Could you answer both of 

those two questions? 

Dr. MAXWELL. I will try, sir. The pay-for-success model I was introduced to last year when I attended as one of the representatives 

for our State at Readynation.org meeting in Charlotte, which was 

their first meeting, and they have brought this pay for success or 

social impact bond concept to the United States based on Great 

Britain’s experience a few years ago looking at recidivism rates for 

juveniles going back into jail, and they had some success in Great 

Britain. The program was brought here by Robert Dugger and 

some other members of the ReadyNation organization, and I can’t 

tell you exactly how many States but Virginia, North and South 

Carolina, I think New Jersey have implemented some of these programs. Some are actually social impact programs, some are pay-forsuccess programs looking at early childhood education and so forth. 

I was intrigued when I heard of the model, and the model, I will 

have to read it for you because it makes a little bit more sense if 

I read it. Under this model, an investor finances the implementation of a proven or evidence-based social intervention program that 

is expected to improve social welfare and save government money 

in excess of the program implementation cost. So the government 

at the end repays the investment only after the program can measurably reduce state expenditures as a result of its successful implementation. So I thought that looking at our drug-free moms and 

babies model, that if it in fact is successful, that we could have this 

end up in a pay-for-success program because you identify women 

early in pregnancy using a screening tool, and as I said, urine is 

not a very good screening tool because if the woman has not done 

a substance in 2 or 3 days, then the urine will be negative, especially for alcohol, but for narcotics, I think that if they use it within 

a 24-hour period of time prior to the test that the urine will be 

positive. But the urine is not universally positive. And so we depend upon another tool. In West Virginia, we are using a tool that 

we call SBIRT. There are other areas. People in Chicago, Dr. Ira 

Chasnoff and his people are using the Five Piece Plus model, which 

is trademarked and so forth, so it is expensive. 

So we use the SBIRT model, and there are people who train others to use this screening tool because the questions have to be 

asked in a specific way in order to get the answers. And so once 

you have screened them and you realize that they are positive, 

then we hope that we can get them into addiction counseling, and 

I have found looking at the programs that we have had in place 

now for the last 2 years or so, that addiction counseling and rehabilitation using behavioral medicine specialists seems to be the way 

90 

to go because pregnancy is a unique opportunity, I think, to address addiction, and we find, I believe, that there is a very positive 

motivating force that occurs when you are pregnant because a 

woman really wants to deliver a healthy baby, believe it or not. 

And so I have found that if we can intervene early in pregnancy, 

that throughout that pregnancy we might be able to have some behavior modification, and if not necessarily take them off the drug 

completely because sometimes that might be dangerous for the life 

of the fetus, but at least reduce their dependence upon the substance, hopefully using buprenorphine. Methadone has been a barrier because the problem is that we have now two people taking 

care of the patient. You have the methadone clinics, which are prescribing the medication to the mom, and sometimes they actually 

increase the amount of methadone that they are using throughout 

pregnancy rather than decreasing it. 

So we like the conversion method where whatever opioid they are 

using gets converted to buprenorphine or Subutex. We can then 

control that mom a little bit more closely. We can wean her off the 

Subutex during pregnancy and reduce the amount of drug the baby 

is exposed to and hopefully reduce their length of stay. They are 

still probably going to withdraw at the end but the withdrawal period will be much shorter than the average of 16 or 20 days, whatever it is, and reduce the cost of stay and also improve the health 

and the welfare of both mom and baby as they go home. 

Mr. MCKINLEY. Thank you very much. I yield back my time. 

Mr. MURPHY. Thank you. Mr. Tonko, you are recognized for 5 

minutes. 

Mr. TONKO. Thank you, Mr. Chair, and welcome to the panelists. 

Thank you for bringing your intellect and your passion to the table. 

It is most helpful. 

In October of last year, the Atlantic magazine published an article titled ‘‘The New Heroin Epidemic,’’ which looked at a number 

of challenges facing addicts in West Virginia. I would like to enter 

this article into the record, Mr. Chair. 

Mr. MURPHY. Without objection. 

[The article has been retained in committee files and can be 

found at: http://docs.house.gov/meetings/if/if02/20150326/ 

103254/hhrg-114-if02-20150326-sd008.pdf.] 

Mr. TONKO. Thank you. 

The article discusses the challenges faced by opiate addicts seeking treatment including lack of doctors, poor reimbursement rates 

by Medicaid, and long waiting lists for some that are seeking treatment. I would like to discuss these barriers with the panel and ask 

whether sufficient resources currently exist to get treatment to 

those who need it. 

Dr. Maxwell, you have tremendous experience caring for patients 

in the State of West Virginia. Do those wishing to get help for 

opioid addiction have sufficient access to effective treatment programs, particularly those in rural areas where addiction specialists 

might be hard to find? 

Dr. MAXWELL. Well, to be honest, sir, I don’t have as much experience as you might think with addiction—people who are addicted 

to opiates. I really am a newborn intensivist, and I take care of the 

babies that are a product of those addicted moms. 

91 

But having said that, I am on the Governor’s Advisory Council 

for Substance Abuse in West Virginia. Governor Tomlin established 

this probably 3, 4, years ago now, and we have an advisory council 

that oversees the work of task forces within the State. We have 

split the State into six different areas, and each area, each of those 

six areas has a task force, and the task force has meetings every 

month or bimonthly at the community level where they get information from the people. And then they bring that to the advisory 

council and we meet once or twice a year to collate all that information in terms of access to care, who is getting what and so forth, 

and where treatment centers are needed, et cetera, and we have 

had some success. The first year we had $7 million to spend, and 

we advised the Governor how to spend that money by identifying 

areas within the State that needed a treatment center, or because 

I am biased and it was for women and pregnant women treatment 

center, so we are working on that problem. I don’t have all that information with me but I can get it to you. 

Mr. TONKO. Thank you. That would be most helpful. 

And Dr. Banta-Green, a similar question. What are the resource 

challenges facing those who wish to find effective treatment for addictions, and are there research challenges in your State of Washington or the surrounding States like Idaho and Oregon? What are 

you seeing out there as a person so deeply invested in this arena? 

Mr. BANTA-GREEN. Thank you for the question. So just to be 

clear, methadone maintenance is done in large treatment facilities, 

generally in larger cities, and there actually is demand for that. We 

actually at one of our large facilities had afternoon dosing last year 

because there was such demand. But in terms of buprenorphine, 

which is really important, because as opiate addiction has spread 

across the states into more rural areas, methadone clinics aren’t 

going to be able to serve all those places. You can’t go and dose 6 

days a week. You need something like buprenorphine. It is much 

easier to access from a geographic perspective. 

But Dr. Roger Rosenblatt at the University of Washington recently published literature on this and found that many, many of 

the rural communities do not even have a single Suboxone provider, and what I think it is important to understand is that there 

is the geographic barrier in terms of many communities don’t even 

have a Suboxone provider. My understanding, and he has done research with those physicians, particularly those who have already 

been trained and waivered by DEA to provide buprenorphine for 

addiction treatment, most still don’t ever prescribe, and the reason 

they do not prescribe is that they are not getting adequate reimbursement is one piece of it, but there are inadequate addiction 

counseling services in their communities and also they do not want 

to be the only doctor prescribing, and in fact, they should not be 

the only doctor prescribing. It is not appropriate to have a single 

provider in a community doing addiction treatment. So those are 

some of the barriers that are faced in terms of having enough physicians step up to prescribe at the same time is really important. 

There are reimbursement issues and then there are also those geographic issues as well. 

92 

Mr. TONKO. So is it basically a function of the trained, talented, 

skilled set of people or is it a function of resources made available 

beyond reimbursement rate levels? 

Mr. BANTA-GREEN. I think in the very short term—and I think 

what is really important is, we need to understand that 

buprenorphine as a medication is overdose prevention. It is longterm overdose prevention. Naloxone is 90-minute overdose prevention. Buprenorphine is potentially many, many years’ worth of 

overdose prevention. So there are clearly reimbursement issues but 

there are also many providers with very poor training in addiction. 

They know very little about addiction. They are very uncomfortable 

with it just as they are very uncomfortable with prescribing 

opioids, which they also have very poor training in, which are pretty important issues, given what we are talking about, that there 

is not adequate training. 

Mr. TONKO. Especially with it being a gateway to the addiction, 

heroin addiction. 

I thank you very much. I see my time is exhausted, and I yield 

back, Mr. Chair. 

Mr. MURPHY. They called votes. We are going to try and get 

through another one. Mr. Griffith, you are recognized for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman. I appreciate that very 

much. 

Dr. Melton, we have been talking some about naloxone, and I 

know there are going to be folks watching this at home today and 

who will be watching it at home over the next week or so as the 

C-SPAN replays it. Can you explain to the public what naloxone 

does in the case of a heroin or opioid overdose? 

Ms. MELTON. Sure. In simple terms, naloxone is an opioid antagonistic or a blocker, and so when naloxone is administered either intranasally, IV, or intramuscularly, it goes to the receptors 

in the brain to block opioid receptors. And so it will kick off heroin, 

other opioids immediately, and by doing that, it reverses respiratory depression and other central nervous system depression 

that leads to death. So what happens is the patient goes into nearly immediate withdrawal, but unfortunately, naloxone only lasts 

for a short period of time and so often additional dosing is needed, 

especially with methadone overdoses, which has a very long activity in the body. 

Mr. GRIFFITH. So it is not to help somebody who has got a problem continue their problem but it is to help them if they have had 

an overdose so that they don’t die. Isn’t that correct? 

Ms. MELTON. Absolutely right. It should never be considered that 

people will use naloxone so that they can have a higher dose of heroin. You ask any addict if they want to go into immediate withdrawal, and they will tell you it is their worst nightmare. 

Mr. GRIFFITH. I recently wrote a bipartisan letter with 22 of my 

colleagues here in the House calling on the Administration to develop practices for naloxone use and reprogram existing funds to 

provide naloxone to medical providers. I think that is a good idea. 

You have mentioned here in your earlier testimony Senator Kaine’s 

bill that provides Good Samaritans with some immunity from liability unless they are acting grossly negligently or maliciously. 

93 

What else do you think that we can do to promote this from a congressional standpoint and make sure that the public is aware of it? 

Ms. MELTON. Well, I think one issue is, I think we are getting 

the awareness going across the country now but access to it, patients being able to afford it is a difficulty. It really needs to be 

mandated coverage by insurance companies so we are able to access it easily at the pharmacy. Virginia’s new legislation will allow 

pharmacists to, through a collaborative practice agreement, write 

prescriptions for patients that come in and ask for it and train 

them on the spot, which I think is a huge step forward, so that will 

increase access, but again, the payment issues are a barrier. 

Mr. GRIFFITH. And nobody is accusing the Virginia legislature of 

being soft on drugs or being liberal in this area, wouldn’t you 

agree? 

Ms. MELTON. I agree. 

Mr. GRIFFITH. Yes, ma’am. 

Now, in my district, our region of southwest Virginia shares borders with four other States: West Virginia, Kentucky, Tennessee 

and North Carolina, two of which are represented here today as 

well. This makes it easy for people to cross State lines to doctorshop and gather multiple prescriptions and from multiple pharmacies to get large amounts of prescription painkillers. What effect 

has this doctor-shopping had on our problem and how might we address it? And I will start with you, Dr. Melton, but the folks from 

Tennessee and West Virginia are welcome to chime in. 

Ms. MELTON. OK. So as I stated in my testimony, Virginia, Tennessee, West Virginia and the other border States will soon be participating in the Interconnect, which allows prescription drug monitoring programs to connect across States lines, so when I have a 

patient that comes in, I automatically run a query, let us say from 

Virginia I can access 15 different States immediately and see if 

they have had any prescriptions filled in other States. It has been 

amazing to see how we are able to identify doctor shoppers and 

identify them as a potential for addiction and get them into treatment. 

Mr. GRIFFITH. And I would have to say for those that don’t the 

area well, you would have to work at it but you could actually hit 

all five states in a single day if you really organized. 

Do either of the folks want to add something? 

Mr. BRASON. From North Carolina, obviously we are along Virginia and Tennessee and so forth, and we have the same program 

to where prescribers can access each individual State so that they 

can check the patient’s history to make sure that they are not 

crossing those lines. 

Mr. GRIFFITH. Very good. 

Dr. Maxwell? 

Dr. MAXWELL. From West Virginia, yes, we have recently passed 

legislation for pharmaceutical tracking, et cetera. 

Just one point is that an unintended consequence from cracking 

down on the pill mills or whatever may be responsible for the increase in heroin use that we are seeing now because the patients 

that are coming in are not on oxycodone or hydrocodone or Percocet 

or any of these drugs any longer but they are on heroin, which is 

94 

more easily available, and that might have been an unintended 

consequence. 

Mr. GRIFFITH. Yes, sir. I appreciate it very much. 

I see my time is up, Mr. Chairman. I thank you and yield back, 

and thank all the witnesses for being here today. 

Mr. MURPHY. Thank you, Mr. Griffith. 

We are going to take a brief break to have votes. We should be 

back here, let us aim for around 12:15, and we will continue on 

with our questions, and I thank the panel for waiting. 

[Recess.] 

Mr. MURPHY. All right. We reconvene this hearing of Oversight 

and Investigations on substance abuse and addiction. 

I am now going to recognize Mr. Mullin of Oklahoma for 5 minutes. 

Mr. MULLIN. Thank you, Mr. Chairman, and Mike, thank you 

again for taking the time to come up here and give your professional opinion. 

Earlier this year, the Oklahoma Department of Health released 

a report that showed that heroin deaths in Oklahoma had increased tenfold in the past 5 years, and between 2007 and 2014, 

treatment centers in Tulsa County saw a 99 percent increase of 

those being admitted for heroin and prescription drug use. That is 

astounding, and one thing that we constantly hear about is where 

are the drugs coming from, and Mike, being that you have 

worked—or Corporal Griffin, sorry—being that you have worked 

undercover for literally 12 years, you continue to arrest people in 

Tulsa and some places even farther than that, but where does the 

barrier happen? What are your limitations? 

Mr. GRIFFIN. So the barrier, or the goal, of course, in all our drug 

investigations is, like I said earlier, we are not targeting individuals addicted to drugs. We are going after the people that are hurting other people by supplying drugs and ruining those people’s 

lives. So when you think of methamphetamine, cocaine, heroin, 

things like that, you are always working up the ladder, so to speak, 

to get to the biggest drug dealer we can find and almost always 

that leads us back to the U.S. border with Mexico. Different from 

that is prescription drugs where in those situations—I hate to use 

the word ‘‘dealer’’ but the dealer in that situation is a doctor or a 

pharmacist. Ninety-nine-plus percent of those people are law-abiding people doing the right thing for all the right reasons. A very 

small percentage of them may be taking advantage of the situation. 

Even in those situations where it is maybe a rogue doctor or 

pharmacist, the laws that are set up in Oklahoma make it almost 

impossible for us to pursue them through the law enforcement for 

the way that we do cases, so that is part of why we have so few 

people dedicated to that and so many dedicated to the other major 

drugs of addiction. 

Mr. MULLIN. And Corporal Griffin, your job is to catch the bad 

guy, and once you catch the first person, sometimes that is the 

user, maybe it is the seller, but you try tracking it back as far as 

you can go? 

Mr. GRIFFIN. Yes, sir. 

Mr. MULLIN. Are you being successful at that? 

95 

Mr. GRIFFIN. We are very successful at it. We have a great relationship with other law enforcement agencies in the area to include 

DEA and FBI. We are constantly working on cases that cross State 

boundaries. We are working a very big case right now. Hopefully 

we will really start moving further down the road within the next 

week or two, and we already know that that case is an international case that has been operating for a long, long time, not 

only in the United States but in Oklahoma, and that is a case we 

will work all the way into Mexico with the help of federal law enforcement agencies. 

But even if we were to say we were successful in that operation 

and get the people that are in Oklahoma and Texas and other 

places that are making millions of dollars from their illegal distribution of methamphetamine, cocaine, even at that level and we 

take them off, the drug-trafficking organization is going to replace 

them and before long they will be right back up and running because it is so easy to smuggle those drugs into our country that if 

we don’t address that issue, I am a hamster on a wheel and just 

keep spinning. 

Mr. MULLIN. Mr. Fitz, Corporal Griffin, his team, they make the 

arrest. The paperwork ends up on your desk. What happens at that 

point? 

Mr. FITZ. Well, again, it depends on the type of case. In my office, we do not negotiate—we don’t dismiss the charges. We plead 

to all the charges, and we basically have the philosophy, get clean 

or get prison, and we have a big meth problem in addition to obviously things such as heroin and cocaine and so forth but our biggest problem actually is methamphetamine, and what we—— 

Mr. MULLIN. Corporal Griffin, you have a tremendous amount of 

knowledge about meth too. 

Mr. GRIFFIN. Methamphetamine is just the biggest drug facing 

Oklahoma right now. 

Mr. FITZ. So what we have, I think something that actually our 

treatment providers are very much—they subscribe to it and they 

buy into it. What we do is, we indicate to the defendant that our 

guidelines on meth, for instance, are fairly high, and we indicate 

to them that they plead as charged to everything and they agree 

that they will go into a treatment program. Usually is a yearlong 

treatment court, family treatment court, adult treatment court, and 

if they get clean, they never go to prison, but if they don’t, then 

they go to prison for a substantial period of time, 4, 5, 6 years. 

Mr. MULLIN. Corporal Griffin made a statement right at the end 

of it, and Mr. Chairman, if you would indulge me just an extra 

minute? Corporal Griffin made a statement that he feels like he is 

a hamster on the wheel. Although he believes in the process, it revolves over and over again. Do you see that same thing happening 

in the court system? I mean, do you see the same people coming 

back over and over again? 

Mr. FITZ. There is a large percentage, but again, that is just the 

tragic reality of drug activity is not only the users but also the 

dealers because oftentimes the penalties are quite lenient. And let 

me just comment on that too. We see cartel activity in Michigan 

also on these drugs. It is a very real problem. And I agree with him 

that I think it is very important to try to address this problem on 

96 

the border but maybe let me also mention something I think that 

is important to keep in mind when dealing with these type of 

issues is that I look at drug activity, and I know many of my colleagues do as well, it is like cutting the grass. You need to remember that grass will never stop growing, drugs will not ever stop 

coming in, but if you stop cutting the grass, your lawn is going to 

get out of control. If we stop vigorous enforcement, we are going to 

see things far worse than what we even see right now. And maybe 

just one other analogy I would give to you also. Sometimes you do 

hear that we can’t arrest our way out of the problem, and I do 

agree with that, that arresting is not the only solution. It has to 

be a multifaceted approach to it. But that doesn’t mean we stop arresting people that do bad things such as drug dealing, murder. We 

are never going to stop murder, we are never going to stop home 

invasions, but we continue to address the problem, and again, because it does have the churn effect, it does have justice, it does involve public safety as well. 

Mr. MULLIN. Corporal Griffin, Mr. Fitz, thank you so much. 

Thank you, Mr. Chairman. 

Mr. MURPHY. Thank you. The gentleman yields back. I now recognize Ms. Brooks for 5 minutes. 

Mrs. BROOKS. Thank you, Mr. Chairman, for holding this hearing. I have to say, I wish that we could actually spend hours upon 

hours discussing this critical problem. 

I have actually been a defense attorney. I have been a United 

States attorney. I was at our State’s community college and have 

dealt with individuals with addiction but nothing really touched me 

as much as when I went and visited the Hope Academy and saw 

a recovery high school and realized that that is the type of program—because I have been involved in the take-downs of the big 

cartels and organizations in our community in the southern district 

of Indiana, but we have to stop it. There is always going to be a 

supply but I want to focus a bit on the demand and what we are 

doing on the demand side, and I really appreciate you being here, 

Ms. Gardner, and want to ask about those recovery supports that 

are so important and what are some of the things—I would like 

you to talk a bit more about how the high school works and about 

what—because there are only 35 in the country but yet you have 

had really very wonderful results. You have alumni who are involved. Fairbanks Hospital has brought the community together, 

but I have to tell you, when I sat in the circle with kids who had 

the support group, and when a young girl said to the group she 

was turning 17 the next day and it was her first birthday in 4 

years that she would be sober, it broke my heart. 

And can you please talk with us about your kids and about what 

are the recovery supports and how should we at the federal level 

be supporting recovery efforts? 

Ms. GARDNER. So a little bit about the school. We are a high 

school so we are 9th through 12th grade, public education, so it is 

a tuition-free school. It looks a little different at our school. They 

start a little later. What we have in the school is called recovery 

coaches. So, it is a dual recovery. It is about gaining better grades 

so that they can go on to higher education but it is also about helping them to stay in long-term recovery. Sometimes that is a daily 

97 

battle. Some kids have been there that have been there, that have 

6 months to a year sober. Some have 30 days. They come to us 

from treatment centers. They come to us from private therapists. 

They come to us from jails, from probation. So we are dealing with 

a wide variety of young people. But the whole goal is to help them 

be in a safe, sober environment and to be able to go on to graduate 

and be successful. 

We have done lots of research with our students in the sense of 

what works for different students who have different drugs of 

choice, but what we know is, is that if we can help them sustain 

daily recovery and we look at long-term recovery as staying abstinence free, doing 12 steps or doing other types of recovery supports, that we know there is a chance to move on and to have their 

brains as their brains are developing become more salient and 

more ability to learn and make better choices and develop some 

positive coping skills, the better the success is going to be. 

Mrs. BROOKS. Can you share with us what you think we at the 

federal level can do to help provide support for programs like 

yours? 

Ms. GARDNER. So we have talked a lot about law enforcement, 

we have talked a lot about medication. Access to treatment is a 

problem across the country. The Affordable Care Act has allowed 

the ability for more people to get it. My opinion in Indiana currently, our young people don’t get to stay long enough in treatment. 

We look at young people like we look at adults. Their brains 

haven’t developed the ability to make informed decisions and so 

you are looking at a young person who is addicted but also having 

to be an adolescent and help them grow with their development. 

They need longer times away from those people, places and things, 

and their ability to access recovery supports, be it schools, be it 

things within a traditional school, be it long-term aftercare kinds 

of programs, which aren’t funded. 

Mrs. BROOKS. Thank you for that. 

Focusing and moving a bit to adults, I do want to ask Mr. Fitz 

because Ms. Gardner talked about treatment and the length of 

treatment. Can you give me your thoughts on the benefits of substance abuse treatment courts in our criminal justice system and 

what you know about them in my brief time remaining? I have 

been a proponent but I would like to hear what you in your role 

believe. 

Mr. FITZ. In my jurisdiction, we happen to have multiple specialty courts. I think it is five or six of them, and we do have a fair 

number of them in the State of Michigan. So my response, I guess, 

would be not just from my perspective but from other prosecutors. 

Prosecutors generally feel that there is a need for more treatment 

because obviously if we can get someone clean, they are less likely 

to come back into the system, and that makes our job easier and 

makes the public safer. 

But again, it is a balance because we recognize that if they don’t 

get clean, that we need to continue to protect the public because 

even drug addicts sometimes do very unfortunate things—child 

abuse, sexual abuse, thefts, things of that sort, crimes of violence. 

So it invasive species balance but prosecutors do see a need for 

more treatment. 

98 

Mrs. BROOKS. Thank you. I yield back. 

Mr. MURPHY. Thank you, Ms. Brooks. 

Ms. DeGette, you have a follow-up question? 

Ms. DEGETTE. I will follow up on what Ms. Brooks was just asking Mr. Fitz. 

We have some drug courts in Denver too and actually the Denver 

district attorney is a good friend of mine, Mitch Morrissey. I don’t 

know if you know him. But one thing—— 

Mr. FITZ. I don’t. 

Ms. DEGETTE. But one thing that drug courts do is, they will 

order people to go—I mean, one reason we have drug courts is exactly the problem that you talked about I think in response to Mr. 

Mullin’s question. You see so much recidivism with drug abusers, 

right? 

Mr. FITZ. Yes. 

Ms. DEGETTE. I mean, it is a terrible problem. So one reason 

they have started drug courts is so that we can find a way to do 

the different kinds of treatment that all of the experts here 

talked—every single expert said it is not just a one-shot deal with 

people who get addicted to these opiates. Since it changes your 

brain, different people need types of treatment. But something that 

is unique about drug courts is that they are trying to send these 

offenders to programs. They are not just saying to folks, OK, now 

go get clean. I mean, they send them into programs, right? 

Mr. FITZ. Really, what especially courts are doing, they are doing 

what prosecutors have lawyers felt that traditional probation 

should be, which is very intensive including—— 

Ms. DEGETTE. Right. 

Mr. FITZ [continuing]. Daily drug testing, the things they need 

to get on the straight and narrow, so to speak. 

Ms. DEGETTE. Right, and that includes programs, which they 

may be given these medications, right? 

Mr. FITZ. Again, there is a split of opinion on that in my state. 

In our jurisdiction, they don’t focus on those, and again, I am not 

educated enough on that to give you the expertise as to whether 

that is good or bad, but I will say that, for instance, Monroe County, one of our counties that I suggested to one of your staffers 

would be a good county in Michigan to talk to, Bill Nichols, the 

prosecutor, they do use those Suboxone—— 

Ms. DEGETTE. Dr. Banta-Green, you are nodding your head here. 

Did you want to talk about that? 

Mr. BANTA-GREEN. Sure. So most drug courts do not allow people 

on medication-assisted treatment or in fact taper them off. I think 

it would be actually great to do the opposite, which is to allow all 

drug courts in fact to require that they allow some type of medication-assisted treatment with methadone or buprenorphine, and as 

I talked about that doctor shortage in rural areas, part of the thing 

they need are supports. So if they had the support of a court that 

they knew had criminal sanctions over this person, right, so they 

are concerned about having all these addicted patients they don’t 

feel like have much control over, partnering with the court—— 

Ms. DEGETTE. Right. 

99 

Mr. BANTA-GREEN [continuing]. Would be a nice partnership and 

maybe a win-win both for the community in terms of having a lot 

less crime—— 

Ms. DEGETTE. And you might see less recidivism too. 

Mr. BANTA-GREEN. Absolutely. 

Ms. DEGETTE. Just one more thing, Mr. Chairman. The Department of Justice has actually said in its discretionary grant program 

for drug courts that drug courts need to use these medication-assisted programs as part of it because it really is medicine, not drug 

addiction, and I guess I would like to put that into the record, Mr. 

Chairman. 

Mr. MURPHY. Sure. Without objection. 

[The information has been retained in committee files and can be 

found at: http://docs.house.gov/meetings/IF/IF02/20150326/ 

103254/HHRG-114-IF02-20150326-SD007.pdf.] 

Ms. DEGETTE. And let me just say, I really appreciate this panel 

coming. Congresswoman Brooks and I were saying during the vote 

how extremely helpful we thought all of your testimony was, so 

thank you, and I yield back. 

Mr. MURPHY. Thank you. The gentlelady yields back. I know that today HHS announced they are going to put $113 

million toward addressing the opioid epidemic focusing on providing training, education, resources including updated prescriber 

guidelines, assist health professionals regarding the over-prescribing, increasing use of naloxone as well as continuing to support the development and the distribution of the lifesaving drug, 

and expanding the use of medication-assisted treatment, the MAT 

program. I think this is good news. We will want to work with 

them. 

We had a recent hearing where the Government Accountability 

Office had told us that federal agencies were not working well together, 112 programs that deal with mental illness. But I think 

Secretary Burwell is really trying to make some changes in this, 

and we applaud that, so we will be looking forward to seeing how 

that does. 

But I want to ask one follow-up question. On that first issue of 

dealing with healthcare professionals who over-prescribe, some doctors have told me that now as they are rated by patients, one of 

the things they are rated on is, you know, the comfort level and 

managing pain, and of course, a physician who is looking to boost 

their ratings doesn’t want that patient to leave their office in pain. 

So there is an incentive there, again, one of these bizarre incentives we have to over-prescribe. Any of you have any comments on 

that and how we deal with that aspect of things? Mr. Brason. 

Mr. BRASON. Yes. We addressed that with the prescribing populations that we have taught and trained on managing pain and appropriate prescribing is instituting best practice methods for doing 

that frontend assessment to determine what kind of risk do we 

have here: do you have a biological risk, do you have a cultural 

risk, do you have an environmental risk. and if those are answered, 

then you know how to appropriately prescribe or put in the safeguards with the urine screens and pill counts and so forth. 

And then coupled with that, the FDA has been approving abusedeterrent formulations to make them available to individuals so 

100 

that they can’t crush and they can’t snort and they can’t inject. So 

when you are combining that federal level work with the local prescriber, you can still prescribe but then it is a much safer product. 

The problem we have is the coverage in order to pay for that, you 

know, that obviously that probably boosts the price of the drug a 

little more so while the copay for this is $5, the copay for this is 

$50, the patient is going to want the $5. It is a generic that is 

abusable, and then we have the issues, and I was recently with a 

doctor in southwest Virginia, a great pain management facility, 

and I said are you prescribing the abuse-deterrent formulations, 

and she says I can’t get coverage, you know, so those are some of 

the areas that, you know, we have got one end doing what they 

want to do and on the other end the prescribers doing what they 

want to do, but the people in the middle that cover this and pay 

for this, you know, are problematic. 

But the prescribers for the most part are willing to do best practice as long as they continue to treat and then have the mechanism 

to help somebody who needs the help. 

Mr. MURPHY. Anybody else have a follow-up statement you want 

to make on that point? 

Dr. Banta-Green. 

Mr. BANTA-GREEN. I would just mention so at the University of 

Washington in terms of trying to limit opioid use and treat pain 

well, and again, as you mentioned, the JCAHO is actually focused 

on pain as the fifth vital sign, and we think that is part of what 

has led a lot of visits. It is easy to quickly treat pain with an opiate, and what we are seeing is that, as I mentioned earlier, it may 

lead to a lot of dysfunction, but if pain is your measure, if symptom 

relief is your pure measure, you are in trouble, because what we 

really care about is functioning, and that is really the idea that we 

are moving towards. There is a nice computer-based support for 

physicians called the Pain Tracker that among other things really 

helps that patient focus every visit on what is their functioning, not 

just their pain level, but really, what is their functioning. 

Mr. MURPHY. Good point. I know I was once on a congressional 

visit to Iraq, and unfortunately, I was in a rollover accident and 

hurt my spine and a little bit paralyzed for a while, but I know— 

and part of this is military medicine, patch them up, ship them out, 

but I know coming back from there, I was on OxyContin, Percocet, 

Tylenol, which is the mildest one, and fentanyl patches, and you 

are that kind of a cocktail and you don’t know which way is up, 

and for myself, I said I am not doing this anymore. I ripped off the 

fentanyl patch and did everything. It was not a pleasant experience. I can’t imagine what it is like for someone who has been taking those kind of things for months or years. 

So as a person who has dealt with folks with substance abuse, 

as a person who has lived with someone with substance abuse, as 

someone who has treated and worked with infants in newborn intensive care units, I want to thank you all for your work. Some of 

you like Corporal Griffin putting your life on the line, thank you 

for your service. Mr. Fitz, thank you for doing those things at a 

prosecutor level. Ms. Gardner, great stories of what is happening 

in the school. Keep up the great work. I understand one of your 

graduates is in medical school? 

101 

Ms. GARDNER. Yes, sir. 

Mr. MURPHY. That is awesome. 

Ms. GARDNER. Thank you. 

Mr. MURPHY. We wish him the best. And all of you, thank you 

for your front line work. 

We will be having other things on this. You heard Ms. DeGette 

talk about we will want to be looking at state policies and federal 

policies. Please don’t let be your last contact. You were brought 

here by some distinguished Members of Congress who believe in a 

lot of what you do. Keep that conversation going, and encourage 

your colleagues from around the country too. We want to know 

what to do here because this deadly epidemic is something that we 

have to address, and we look forward to hearing your expert opinions on this. 

Thank you all so much. Have a wonderful Easter. And it is now 

adjourned. 

[Whereupon, at 12:40 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

PREPARED STATEMENT OF HON. FRANK PALLONE, JR. 

Mr. Chairman, thank you for convening this hearing today on this important 

issue. 

Prescription drug abuse is an epidemic in the United States. We see its effects 

throughout the country in all of our districts. In New Jersey, we have seen the rate 

of drug overdose deaths nearly double in the last ten years. 

I want to use today’s hearing to understand what we can do to combat this epidemic. We must work together - at the local, state, and federal levels - to expand 

effective prevention and treatment efforts for opioid abuse. 

We need to focus on what works. Research tell us that medication-assisted treatment combined with counseling is the most effective method of treating opioid addictions. Yet throughout the country, many treatment facilities continue to be based 

in an abstinence-only model that prohibits the use of medication. We need to understand why that is the case and how we can increase access to medication-assisted 

treatment. 

I want to highlight some of the work being done in New Jersey to address the 

opioid addiction epidemic. In 2013, the New Jersey legislature passed a law to expand access to naloxone, a life-saving medication that reverses the effects of a drug 

overdose. Nearly 30 states now have such laws. 

In my district, Rutgers University was one of the first colleges to offer a residential program for the growing number of students with substance use disorders. In 

1988, the University first established the Collegiate Recovery Community to provide 

a safe place for students in recovery. There are now over twenty such programs 

across the nation. 

Just outside my district, the Raymond J. Lesniak Recovery High School, New Jersey’s first and only public recovery high school, opened earlier this year. It serves 

students who wish to recover from their substance use disorders in a safe environment. 

Here in Congress, we took significant steps to expand access to health care for 

all Americans, including those with substance use disorders, with the passage of the 

Affordable Care Act. For many addicts, the lack of insurance or the cost of treatment presents an insurmountable barrier to receive the help they need. The Affordable Care Act addresses these problems by expanding insurance coverage and requiring that insurance cover the cost of substance abuse services. This will mean 

that millions of people will have access to the tools they need to break their addictions. 

I also want to speak for a moment in support of the reauthorization of the National All Schedules Prescription Electronic Reporting Act - or NASPER. This legislation helps states set up prescription drug monitoring programs in order to combat 

prescription drug abuse and supports interoperability of state programs. It is critical 

that we continue support for this program through federal funding. 

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I want to thank all the witnesses for appearing before us today. I’m eager to hear 

about the work you’re doing to combat this epidemic.I yield the remainder of my 

time to Rep. Kennedy. 

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